锚钉在创伤骨科应用ppt课件

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level,*,锚钉在创伤骨科应用文档ppt,锚钉在创伤骨科应用文档ppt,1,谁需要用到带线锚钉,?,与关节附近肌腱韧带损伤相关的专业医务人员：,手外科医生,创伤外科医生,关节镜外科医生,矫形外科医生,足踝外科医生,施乐辉,谁需要用到带线锚钉? 与关节附近肌腱韧带损伤相关的专,2,目前带线锚钉多用于哪里,?,肩关节,肘关节,手和腕关节,膝关节,足和踝关节,髋关节,骨盆,颌面部,施乐辉,目前带线锚钉多用于哪里?肩关节施乐辉,3,关节附近,肌腱或韧带的创伤性断裂机制,锐器切割或机械暴力牵拉,整齐性断裂,腱性组织成撕脱性、 断面成马尾状,骨面撕脱骨折,施乐辉,关节附近肌腱或韧带的创伤性断裂机制锐器切割或机械暴力牵拉,4,传统的修复方法及其不足之处,石膏或绷带外固定法、钢丝缝合法、缝线缝合法、,骨开洞后腱性组织置入固定法等,不牢固,时间长且疗效不佳,关节粘连、僵硬,组织再次断裂,创伤部位残留疼痛,部分功能丧失,施乐辉,传统的修复方法及其不足之处石膏或绷带外固定法、钢丝缝合法、缝,5,针对不同的肌腱或韧带损伤,锚钉的应用,施乐辉,针对不同的肌腱或韧带损伤施乐辉,6,肩关节关节周围损伤的应用,施乐辉,肩关节关节周围损伤的应用施乐辉,7,水平,垂直,水平拉开,垂直,&,水平,内部实质,锚钉修复,锚钉修复,&,缝线修复,缝线修复,锚钉修复,&,缝线修复,缝线修复,肩袖撕裂类型修复适应症,施乐辉,肩袖,水平垂直水平拉开垂直& 水平内部实质锚钉修复锚钉修复 & 缝,8,TwinFix Ti 3.5,、,5.0 mm,，,Ultra TwinFix Ti 4.5,、,5.5,、,6.5mm,，,Ultra TwinFix PK 4.5,、,5.5,、,6.5 mm,骨质疏松，需要高固定强度,.,需要多个固定缝线,医生要求,PEEK,材料,肩袖修复锚钉的选择,TwinFix Ti 3.5、5.0 mm，肩袖修复锚钉的选,9,Bankart,损伤,Bankart,损伤,通常是指盂唇的前下部,自肩胛盂中线以下部位撕脱,结果导致盂唇失去了正常止,动垫的效应,.,广州中医药大学第一附属医院,Bankart 损伤Bankart损伤广州中医药大学第一附属,10,Humeral Head,施乐辉,Bankart,损伤,Humeral Head施乐辉Bankart 损伤,11,Suture Anchor Technique,锐性离断者-直接植入锚钉,Resect Lateral Epicondyle & expose raw cancellous surface,跟腱附着点的位置疼痛肿胀,如果感到阻力很大时，需要钻孔!,Ultra TwinFix PK 4.,关节面附近时-勿将锚钉置于关节内，防止术后影响,ECU Extensor Carpi Ulnaris尺侧腕伸肌,Repair of UCL,用带线锚钉重新连接跟腱,TwinFix Ti 3.,Mobilize Extensor Origin,Repair using Suture Anchor,外侧踝关节不稳定 基本修复,肱二头肌腱远端断裂锚钉修复（单切口）,Ultra TwinFix Ti 4.,Mini TAG 2.,Medial UCL Complex,尺侧副韧带UCL损伤的症状,SLAP,损伤,施乐辉,Suture Anchor TechniqueSLAP 损伤,12,肩盂唇修复锚钉的选择,TwinFix Ti 2.8,、,3.5mm,Bioraptor 2.9mm,PEEK,材料选择,肩盂唇修复锚钉的选择,13,肘关节周围损伤的应用,施乐辉,肘关节周围损伤的应用施乐辉,14,二头肌腱修补,网球肘修补,尺、桡侧副韧带修补,TwinFix Ti 2.8 mm or TwinFix 3.5 mm,选择锚钉,-,肘,选择锚钉-肘,15,肱二头肌腱远端断裂,肱骨内侧髁,尺骨茎突,撕裂的二头肌腱,常见于中年男性的,dominant,手,施乐辉,肱二头肌腱远端断裂肱骨内侧髁尺骨茎突撕裂的二头肌腱常见于中年,16,肱二头肌腱远端断裂锚钉修复（单切口）,施乐辉,肱二头肌腱远端断裂锚钉修复（单切口）施乐辉,17,Suture Anchor Technique,1 incisionLess risk of infection & less scarring,No risk of bone tunnel breakage,Easier to perform, saves OR time.,施乐辉,Suture Anchor Technique1 incis,18,外上髁炎治疗,ECRB,桡侧腕短伸肌的小损伤, 非感染性,手术治疗不常用,(,报道,4-8%,的病例用手术治疗,),外科手术,开放或镜下松解,(shaver or RF),松解，重连接,广州中医药大学第一附属医院,外上髁炎治疗ECRB桡侧腕短伸肌的小损伤, 非感染性广州中医,19,Location of ECRB,ECRL,桡侧腕长伸肌,ECRB,桡侧腕短伸肌,ECU,Extensor Carpi Ulnaris,尺侧腕伸肌,施乐辉,Location of ECRBECRLECRB,20,ECRB Location Continued,施乐辉,ECRB Location Continued施乐辉,21,找到,ECRB,松解,ECRB,Resect Lateral Epicondyle & expose raw cancellous surface,Mobilize Extensor Origin,用2个锚钉 重新连接到外上髁,施乐辉,找到ECRB施乐辉,22,足踝关节周围损伤的应用,Most commonly injured,开放或镜下松解(shaver or RF),Humeral Head,TwinFix Ti 2.,腱性组织止点骨块撕脱者-用12枚锚钉直接在原位,ECRB 桡侧腕短伸肌,骨质疏松者-选择直径大的锚钉、在骨面开骨槽后置入,自肩胛盂中线以下部位撕脱,用带线锚钉重新连接跟腱,锐性离断者-直接植入锚钉,穿过外踝的孔(腓骨附着),Bioraptor 2.,目前带线锚钉多用于哪里?,Bioraptor 2.,Repair using Suture Anchor,Humeral Head,Lateral Ankle Instability Ligaments Affected,TwinFix锚钉产品线,20-30岁的年轻女性多见,侧副韧带修复,Medial UCL Complex,斜束,前束,后束,施乐辉,足踝关节周围损伤的应用侧副韧带修复Medial UCL Co,23,尺侧副韧带,UCL,损伤的症状,过头投掷运动时缺乏稳定性,在做过头投掷运动时手臂不能用力,过头投掷运动时不能控制,施乐辉,尺侧副韧带UCL损伤的症状过头投掷运动时缺乏稳定性施乐辉,24,Repair of UCL,传统方法复杂，费时,可用带线锚钉固定,简化手术 &省时,减少骨隧道穿肌腱造成的创伤,施乐辉,Repair of UCL传统方法复杂，费时施乐辉,25,膝关节周围损伤的应用,施乐辉,膝关节周围损伤的应用施乐辉,26,施乐辉,选择锚钉,-,膝,所有韧带,/,肌腱与骨的连接,MCL/LCL Repair,内侧或外侧副韧带修补,TwinFix Ti 3.5,、,5.0 mm,Ultra TwinFix Ti 4.5,、,5.5 mm,Ultra TwinFix PK 4.5,、,5.5 mm,施乐辉选择锚钉-膝,27,膝,施乐辉,膝施乐辉,28,足踝关节周围损伤的应用,施乐辉,足踝关节周围损伤的应用施乐辉,29,施乐辉,选择锚钉,-,足,/,踝,外侧和内侧不稳,跟腱修补,拇外翻重建,足中部重建,拓韧带重建,TwinFix Ti 2.8,、,3.5,、,5.0 mm,Ultra TwinFix Ti 4.5,、,5.5 mm,Ultra TwinFix PK 4.5,、,5.5 mm,施乐辉选择锚钉-足/踝 外侧和内侧不稳,30,拇外翻,施乐辉,拇外翻施乐辉,31,Lateral Ankle Instability,Ligaments Affected,距腓前,韧带,跟腓韧带,Most commonly injured,施乐辉,Lateral Ankle Instability Li,32,踝关节外侧不稳定,ATF Repair,施乐辉,踝关节外侧不稳定施乐辉,33,外侧踝关节不稳定,基本修复,施乐辉,外侧踝关节不稳定 基本修复施乐辉,34,踝关节外侧不稳定 ,Secondary Repair,用于慢性不稳定,用腓骨短肌腱的前,穿过外踝的孔,(,腓骨附着,),用锚钉固定在距骨的外侧,腓骨短肌,距骨,施乐辉,踝关节外侧不稳定 Secondary Repair用于慢,35,跟腱修复,Split, Rupture & Haglund,s Deformity,Tendo Calcaneous,(Achilles Tendon),施乐辉,跟腱修复Split, Rupture & Haglunds,36,肱二头肌腱远端断裂锚钉修复（单切口）,锚钉在创伤骨科应用文档ppt,医生要求PEEK材料,所有韧带/肌腱与骨的连接,Easier to perform, saves OR time.,Suture Anchor Technique,踝关节外侧不稳定 Secondary Repair,TwinFix Ti 2.,Location of ECRB,尺侧副韧带UCL损伤的症状,Recommended,1 incisionLess risk of infection & less scarring,开放或镜下松解(shaver or RF),Repair using Suture Anchor,Tendo Calcaneous (Achilles Tendon),锚钉在创伤骨科应用文档ppt,TwinFix Ti 3.,如果感到阻力很大时，需要钻孔!,肱二头肌腱远端断裂锚钉修复（单切口）,跟腱断裂,施乐辉,肱二头肌腱远端断裂锚钉修复（单切口）跟腱断裂施乐辉,37,Haglund,s Deformity(,“,Pump Bump,”,),跟腱附着点的位置疼痛肿胀,20-30,岁的年轻女性多见,可有滑囊刺激症状,切除感染的组织,用带线锚钉重新连接跟腱,广州中医药大学第一附属医院,Haglunds Deformity(“Pump Bump,38,手部韧带肌腱损伤的应用,施乐辉,手部韧带肌腱损伤的应用施乐辉,39,舟月骨韧带重建,尺侧副韧带重建,桡侧副韧带重建,TwinFix Ti 2.8,、,3.5mm,Mini TAG 2.0mm,施乐辉,锚钉选择,-,手,/,腕,施乐辉锚钉选择-手/腕,40,手,/,腕 部韧带,手,掌部视图,手,背部视图,侧副韧带,尺侧副韧带,手背腕骨韧带,手背桡腕韧带,横间韧带,施乐辉,手/腕 部韧带手背部视图尺侧副韧带手背腕骨韧带手背桡腕韧带,41,指深屈肌腱(,aka Jersey Finger or FDP),Gold Standard Repair,Anchors,Recommended,施乐辉,指深屈肌腱(aka Jersey Finger or FD,42,指伸肌腱,锤状指,Mallet Finger,Repair using Suture Anchor,施乐辉,指伸肌腱 锤状指Mallet FingerRepai,43,指伸肌腱 ,Boutonniere（,钮扣指）,Boutonniere Deformity,Repair option using Suture Anchors,施乐辉,指伸肌腱 Boutonniere（钮扣指）Boutonn,44,腕部舟月韧带,ScaphoLunate repair using Suture anchors,月状的,舟状的,桡骨,广州中医药大学第一附属医院,腕部舟月韧带ScaphoLunate repair usi,45,锚钉植入操作步骤,&,技巧,施乐辉,锚钉植入操作步骤&技巧 施乐辉,46,踝关节外侧不稳定 Secondary Repair,8 mm or TwinFix 3.,Ultra TwinFix PK 4.,开放或镜下松解(shaver or RF),常见于中年男性的dominant手,Suture Anchor Technique,用带线锚钉重新连接跟腱,肱二头肌腱远端断裂锚钉修复（单切口）,在做过头投掷运动时手臂不能用力,Resect Lateral Epicondyle & expose raw cancellous surface,TwinFix锚钉产品线,传统的修复方法及其不足之处,Q: TwinFix AB 如何?,用2个锚钉 重新连接到外上髁,较粗大的腱性组织-股四头肌键、膑腱、跟腱、 内侧或外侧,目前带线锚钉多用于哪里?,石膏或绷带外固定法、钢丝缝合法、缝线缝合法、,Repair of UCL,Mini TAG 2.,开放或镜下松解(shaver or RF),肱二头肌腱远端断裂锚钉修复（单切口）,TwinFix Ti 3.,锚钉操作步骤一,打磨骨面，致粗糙渗血,施乐辉,踝关节外侧不稳定 Secondary Repair锚钉操,47,锚钉操作步骤二,植入锚钉，位于皮质骨,2-3mm,处,施乐辉,锚钉操作步骤二施乐辉,48,锚钉操作步骤三,将缝线打结，使肌腱固 定于骨面上,施乐辉,锚钉操作步骤三施乐辉,49,锚钉植入技巧,骨面完全撕脱者,-,打磨出粗糙血床，便于肌腱牢固愈合,锐性离断者,-,直接植入锚钉,骨质疏松者,-,选择直径大的锚钉、在骨面开骨槽后置入,骨水泥，利用骨水泥将锚钉固定于骨骼上,施乐辉,锚钉植入技巧骨面完全撕脱者-打磨出粗糙血床，便于肌腱牢固,50,锚钉植入技巧,腱性组织止点骨块撕脱者,-,用,1,2,枚锚钉直接在原位,将骨块缝合固定,关节面附近时,-,勿将锚钉置于关节内，防止术后影响,关节功能,施乐辉,锚钉植入技巧腱性组织止点骨块撕脱者-用12枚锚钉直接在,51,注意：选用锚钉的适应症,较粗大的腱性组织,-,股四头肌键、膑腱、跟腱、 内侧或外侧,副韧带（在止点,2,厘米内损伤）,较细小的腱性组织,-,屈腕或伸腕肌键、指伸屈肌腱,（在止点,1,厘米内损伤）,施乐辉,注意：选用锚钉的适应症较粗大的腱性组织-股四头肌键、膑腱,52,选择锚钉常见问题,Q:,有必要在置入锚钉前钻孔吗,?,A:,使用,2,个手指拧入锚钉，通常用拇指和食指拧手柄。如果感到阻力很大时，需要钻孔,!,Q: TwinFix AB,如何,?,A:,必须钻孔,施乐辉,选择锚钉常见问题Q: 有必要在置入锚钉前钻孔吗?施乐辉,53,TwinFix,锚钉产品线,施乐辉,TwinFix锚钉产品线施乐辉,54,谢 谢,广州中医药大学第一附属医院,谢 谢广州中医药大学第一附属医院,55,在做过头投掷运动时手臂不能用力,Repair option using Suture Anchors,用带线锚钉重新连接跟腱,骨质疏松者-选择直径大的锚钉、在骨面开骨槽后置入,1 incisionLess risk of infection & less scarring,锐器切割或机械暴力牵拉,Lateral Ankle Instability Ligaments Affected,在做过头投掷运动时手臂不能用力,指伸肌腱 锤状指,外侧踝关节不稳定 基本修复,尺、桡侧副韧带修补,在做过头投掷运动时手臂不能用力,ECU Extensor Carpi Ulnaris尺侧腕伸肌,将骨块缝合固定,腱性组织止点骨块撕脱者-用12枚锚钉直接在原位,肱二头肌腱远端断裂锚钉修复（单切口）,自肩胛盂中线以下部位撕脱,锚钉植入操作步骤&技巧,Mini TAG 2.,Tendo Calcaneous (Achilles Tendon),肱二头肌腱远端断裂锚钉修复（单切口）,锐器切割或机械暴力牵拉,Repair option using Suture Anchors,Tendo Calcaneous (Achilles Tendon),Repair option using Suture Anchors,腱性组织止点骨块撕脱者-用12枚锚钉直接在原位,TwinFix Ti 3.,Resect Lateral Epicondyle & expose raw cancellous surface,TwinFix Ti 3.,锐性离断者-直接植入锚钉,Repair using Suture Anchor,Repair using Suture Anchor,目前带线锚钉多用于哪里?,MCL/LCL Repair 内侧或外侧副韧带修补,肱二头肌腱远端断裂锚钉修复（单切口）,用带线锚钉重新连接跟腱,将骨块缝合固定,在做过头投掷运动时手臂不能用力,TwinFix Ti 2.,针对不同的肌腱或韧带损伤,锚钉修复 & 缝线修复,将缝线打结，使肌腱固 定于骨面上,Ultra TwinFix Ti 4.,自肩胛盂中线以下部位撕脱,锚钉在创伤骨科应用文档ppt,Mini TAG 2.,传统的修复方法及其不足之处,用带线锚钉重新连接跟腱,Mobilize Extensor Origin,Bioraptor 2.,TwinFix Ti 3.,尺侧副韧带UCL损伤的症状,Lateral Ankle Instability Ligaments Affected,尺、桡侧副韧带修补,过头投掷运动时缺乏稳定性,Location of ECRB,Boutonniere Deformity,Repair using Suture Anchor,锐器切割或机械暴力牵拉,谢谢观看！,在做过头投掷运动时手臂不能用力Mini TAG 2.在做过头,56,