PPT医学课件钢板的类型和功能讲义

,Mastertextformat bearbeiten,Zweite Ebene,Dritte Ebene,*,中国,AO,讲师团教育系列,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,历史,Lane(1895),腐蚀,Lambotte(1909),Sherman(1912),强度不足,Egger(1948),槽型钢板,Danis(1949),加压理论，里程碑,Bagby,and Jane(1958),椭圆孔设计,Muller(1965),加压钢板（加压器）,Schenk and Willenegger(1969),DCP,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,螺钉和,/或接骨板,?,螺钉是重建关节或干骺端骨折最佳最有用的内植物,钢板结合螺钉为骨干骨折提供更好的稳定性,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,1958,年的工具和解决方法,直钢板,圆形孔,皮质骨螺钉和松质骨螺钉,接骨板,几乎没有可屈性，螺钉仅可垂直固定,复位和固定需要广泛骨暴露,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,今天,:,不同的钢板,-,不同的适应症和使用方法,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,如何选择？,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,接骨板的优点,解剖重建,坚强固定,保留骨内膜血供,有助于功能复位,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,传统接骨板的缺点,暴露较广泛,软组织损伤问题,生物力学上偏心固定,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,坚强固定,-,应力遮挡,-,骨质疏松与骨萎缩,取钢板后，再骨折。,Hidaka S,发生率达,20%,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,接骨板的类型和功能,-,特殊设计分型,DCP,动力加压钢板,LC-DCP,有限接能动力加压钢板,管状钢板,重建钢板,角钢板,滑动螺钉钢板,解剖钢板,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,DCP,动力加压钢板,螺孔侧位横截面是不规则碗状,螺孔正位是椭圆形,拧紧螺钉引起,钢板与骨之间的移动,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,加压和,/或固定,中心位置入的螺钉没有加压效果,要有动力加压效果，螺钉必须偏心置入,钻孔位置至关重要,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,骨片间加压和接骨板固定,通过接骨板螺孔放置拉力螺钉可以增加斜行骨干骨折的稳定性,螺钉拧入钢板螺孔时倾斜与钢板水平交界处为钝角，向下，水平方向滑动，轴向加压作用。,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,接骨板的塑形,接骨板的塑形要符合骨,的解剖形态,柔软模板进行预先塑形,用折弯钳、大型折弯器或折弯棒塑形接骨板,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,LC-DCP,有限接触,-,动力加压钢板,底面切割槽，与骨面有限接触，接触减少，损伤减少,侧位横截面是规则碗形,钢板两边倾斜成梯形,钢板下间断切割为弓状,螺孔由两个倾斜的水平圆柱体构成,相交在同一角度,允许双方向加压,螺孔与切割槽平均分布,-,确保应力平均分布,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,管型钢板,1/3 1/4,通过钢板椭圆孔向心性加压,边缘嵌入骨膜维持旋转稳定,1/3,外踝,/,中和作用,肱骨远端、跟骨骨折,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,重建钢板,钢板两侧,V,形凹口,三维塑型,自动加压作用（螺钉孔）,骨盆，锁骨，肩胛骨骨折,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,角钢板,角稳定作用,一端为,U,形的叶片状,与侧方钢板成,95,或,130,股骨近、远端骨折,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,滑动髋螺钉,松质骨拉力螺钉,骨干上在某一角度带有套筒的侧方钢板,在负重时螺钉盖过套筒滑动，使骨折端加压,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,两个基本原则,1,拉力螺钉和套筒过骨折线入骨折远端,2,拉力螺钉必在套筒内滑动一段距离才能闭合骨折间隙对骨折端完全加压,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,接骨板的类型和功能,-,生物力学特性,中和钢板,支持钢板,加压钢板,桥接钢板,张力带,防滑动钢板,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,中和接骨板,用拉力螺钉做坚强内固定，,用接骨板做中和或保护,防止外力作用于骨折所产生的扭矩。弯曲应力和剪切应力，对拉力螺钉起保护作用。,穿过接骨板或单独用,拉力螺钉对骨片间加压,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,加压钢板,三种方法在骨骼的长轴方向产生加压作用,钢板预弯,利用加压的钢板的特殊设计,螺钉孔的特殊几何形状,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,加压方法,外部加压器加压,偏心放置螺钉,加压钢板,对横形或短斜形骨折做轴向加压,近接骨板处锐角骨一侧可加压,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,加压接骨板,用一枚拉力螺钉穿过接骨板提供额外的稳定性,使用接骨板前先做预弯，以防对侧骨皮质形成间隙,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,张力带接骨板,偏心负荷骨的固定原则,接骨板必须放在张力侧,对侧骨皮质必须能抵抗压力,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,支撑接骨板,中和在骨折轴向施加负荷时所产生的弯曲应力，压缩力，剪切力。对骨皮质有支持作用，有效对抗可能产生的移位，降低关节畸形的发生率。,最适用于干骺端或骨骺部位,固定剪切或劈裂骨折,要获得支撑效果螺钉必须放在支撑接骨板的螺孔内,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,T,形 胫骨外侧平台,匙形 胫骨远端 干骺端骨折,三叶草 胫骨远端 肱骨近端 股骨远端,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,桥接接骨板,用于粉碎性骨干骨折,生物学固定,恢复长度，轴线和旋转至关重要,不干扰骨折区域,建议用锁定加压接骨板,钢板的固定远离骨折块,螺钉固定在钢板两端,维持粉碎骨折的骨骼长度,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,回顾与展望,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,骨折内固定治疗理念的改变,骨折解剖复位,牢固内固定,(,加压作用,),保留血供,早期无痛活动,1958,年,20,世纪,90,年代起,不强求解剖复位,生物学固定（夹板作用）,微创手术、间接复位、,保护血供,早期活动,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,1960,年圆孔接骨板,全球首次推广标准化的工具及内植物,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,1969,年成功设计了,DCP,接骨板,DCP-,动力加压接骨板,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,1981,年全球首创,LC,DCP,有限接触动力加压接骨板,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,1990,年微创内固定系统,LISS,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,2001,年,接骨板发展的里程碑,LCP,锁定加压接骨板,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,LCP,结合孔,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,普通接骨板螺钉技术,锁定接骨板螺钉技术,拉力螺钉技术,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Hospital,谢谢！,Department of Orthopaedic Surgery,Shanghai Sixth Peoples Ho