Zimmer MIS Multi-Reference, Хирургическая техника, Страница: 26 / 48

Zimmer MIS Multi-Reference 4-in-1 Femoral Instrumentation Surgical Technique
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Position the Guide
Place the spring arms of the Ankle
Clamp around the ankle proximal to the
malleoli and loosen the anterior knob
that provides mediolateral adjustment
at the ankle. If preferred, the Ankle
Spring may be used instead of the
Ankle Clamp.
Loosen the knob on the proximal end
of the Distal Telescoping Rod and
adjust the length of the guide until
the Tibial Cut Guide is positioned at
the approximate depth of cut. With
the Tibial Cut Guide and Tubercle
Anchor contacting the bone, move
the Tibial Cut Guide mediolaterally to
align the rod with the medial third of
the tibial tubercle (Fig. 5g). This will
usually place the proximal end of the
Adjustable Rod so it is centered below
the intercondylar eminence. The Tibial
Cut Guide will contact the tibia at an
oblique angle and the low-profile
portion of the cutting head will fit
under the patellar tendon. The Tubercle
Anchor is shaped to fit between the
patellar tendon and the base of the
cutting head.
NOTE:
Be sure that only the low-profile
portion of the cutting head extends
beneath the patellar tendon (Fig. 5h).
When correctly aligned, the Distal
Telescoping Rod and Adjustable Rod
should be parallel to the tibia in the
coronal and sagittal planes. To help
avoid rotational malalignment of the
rod, check its position from a direct
anterior view, ie, stand at the foot of
the operating table.
Adjust the distal end of the MIS Distal
Telescoping Rod by moving the slide at
the foot of the rod medially or laterally
until the guide is aligned with the
mechanical axis of the tibia. The end of
the MIS Distal Telescoping Rod should
be positioned about 5mm-10mm
medial to the midpoint between the
palpable medial and lateral malleoli.
The tip should point to the second toe
(Fig. 5i). When the proper M/L position
is achieved, tighten the anterior knob
to secure the MIS Distal Telescoping
Rod to the Ankle Bar.
Loosen the knob on the side of the
distal end of the MIS Distal Telescoping
Rod. Then use the slide adjustment to
align the rod in the sagittal plane so it
is parallel to the anterior tibial shaft.
This will create a 7° posterior tibial
slope. If more or less slope is desired,
use the slide adjustment to obtain the
desired slope. Then tighten the knob.
If there is a bulky bandage around the
ankle, adjust the rod to accommodate
the bandage. This will help ensure
that the tibia will be cut with the
proper slope.
Fig. 5i
Fig. 5h
Fig. 5g