萬向鎖定加壓掌側(cè)雙柱接骨板治療橈骨遠(yuǎn)端骨折

1、萬向鎖定加壓掌側(cè)雙柱接骨板2.4,,橈骨遠(yuǎn)端骨折,最常見的骨折，沒有之一 (15%）> 80%: 老年女性 (60歲以上)預(yù)計(jì)至2030年增加到50％,Paul W. Thompson et al: The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in Dor

2、set, UK, Injury Volume 35, Issue 5, p.462-466, May 2004,,,Time,Innovation,,> 120 plates,VA,VA,萬向鎖定加壓掌側(cè)雙柱接骨板2.4,橈骨遠(yuǎn)端關(guān)節(jié)內(nèi)或關(guān)節(jié)外的骨折，以及截骨后的固定,為什么是“雙柱”：三柱理論,A,B,C,,3柱理論,成角鎖定,萬向鎖定,,為什么是“萬向”：萬向鎖定的原理,偏離中軸15°內(nèi)任意方向植入螺釘四柱螺紋 +

3、 球形螺釘頭,30°,,+=,VA-LCP VS. LCP,LCP,VA-LCP,,,,,,15°,,,15°,,萬向 VS. 標(biāo)準(zhǔn)鎖定螺釘,錐形螺釘頭,圓形螺釘頭,標(biāo)準(zhǔn)鎖定螺釘,萬向鎖定螺釘,萬向成角的優(yōu)勢,適應(yīng)特殊的骨折類型，抓持某些特定的骨折塊螺釘定位更精準(zhǔn)，覆蓋范圍更大兩枚螺釘配合，可實(shí)現(xiàn)旋轉(zhuǎn)穩(wěn)定的固定,內(nèi)植物,頭部7孔,頭部6孔,頭部6孔，窄型,19.5 mm,22.0 mm,25.5 mm

4、,寬度,內(nèi)植物,,,,25.5 mm,頭部7孔 頭部6孔 頭部6孔 ，窄型,,,,,7.5 mm,,,,,47 - 77 mm,,,,22 mm,,,,7.5 mm,,,,45 - 75 mm,,,,19.5 mm,,,,7.5 mm,,,42 - 72 mm,,即使不采用萬向成角鎖定，釘孔的排列和預(yù)設(shè)角度也已經(jīng)可以應(yīng)對大多數(shù)基本的骨折類型骨折類型多種多樣，在固定角鎖定無法處理的時候，可采用萬向成角鎖定,

5、預(yù)設(shè)角鎖定的螺釘排列,萬向鎖定,Main Features / Benefits,,,,,,,,,Main Features / Benefits,1 Picture by Prof. Ladislav Nagy, Balgrist Clinic Zurich,Main Features / Benefits,Main Features / Benefits: Narrow,,,Features and Benefits: VA-But

6、tress Pin,VA-Buttress Pin 1.8 mm,工具配置: 術(shù)中選擇萬向或固定角鎖定,,,產(chǎn)品特點(diǎn),,螺釘,*只成 0°,*,*,支撐度：VA LCP VS. LCP,,支撐度：VA LCP VS. LCP,增加了抗彎曲力,雙柱的穩(wěn)定性是juxtaart.接骨板的兩倍！,支撐度比較,Pre-op,Post-op,Note: crossing screwsNote: scaphoid fracture and

7、 HCS 2.4,X-Ray Examples,24 year old male with AO 23C2.1 fracture,Post-op,Pre-op,Note built-in feature:Using pre-defined angles screws appear in one row in 20° inclined lateral view,,,,20°,,Fall,77 year old fem

8、ale with AO 23C1 fracture,X-Ray Examples,Pre-op,Post-op,Note: crossing screws forming a basket to support the articular surface,82 year old female with AO 23C2 fracture,X-Ray Examples,Pre-op,Post-op,Note: very distal ang

9、ulation of styloid screw (in this case it is a 2.4 cortex, works also with VA-LCP).,75 year old female with AO 23A3 fracture,X-Ray Examples,Pre-op,Post-op,Note: use of K wires for preliminary fixation,Note: screws have i

10、ntentionally been chosen to be far below opposite cortex,53 year old small statued female with AO 23 A3 fracture,X-Ray Examples,掌側(cè)入路,手術(shù)操作要點(diǎn),復(fù)位骨折塊放置接骨板在LCP加長孔植入皮質(zhì)螺釘2.4 mm或2.7 mm,手術(shù)操作要點(diǎn),可使用1.25 mm克氏針螺釘和克氏針植入的順序由骨折類型決定,

11、手術(shù)操作要點(diǎn),鉆萬向鎖定螺釘孔萬向LCP導(dǎo)鉆嵌入萬向鎖定螺釘孔內(nèi)確認(rèn)嵌入后鉆孔,,,30°,手術(shù)操作要點(diǎn),固定成角導(dǎo)鉆可以解決80%的骨折類型,Note: 帶螺紋的LCP導(dǎo)鉆不適用,,,固定成角螺釘：方法一,手術(shù)操作要點(diǎn),導(dǎo)向模塊結(jié)合快速導(dǎo)鉆,,固定成角螺釘：方法二,手術(shù)操作要點(diǎn),在遠(yuǎn)端植入萬向鎖定螺釘 確認(rèn)螺釘?shù)竭_(dá)理想位置后，再進(jìn)行最后的鎖緊步驟,手術(shù)操作要點(diǎn),,0.8Nm扭力限制扳手在執(zhí)行最后鎖緊螺釘步

12、驟以后， 不能再此重新植入螺釘,螺釘鎖定,手術(shù)操作要點(diǎn),使用C-arm最后鑒別螺釘位置關(guān)閉切口,重要信息：,由于解剖預(yù)塑型，螺釘中立位固定后將向遠(yuǎn)段成角20°，需要在C－arm下控制， 以免穿入關(guān)節(jié)腔,20° 向外傾斜－側(cè)位片,,4枚螺釘螺釘投射成一線,手術(shù)操作要點(diǎn),螺釘在沒有鎖定的情況下， 如果角度不理想，可最多從萬向螺釘孔里取出3次；完成鎖定后，該萬向鎖定螺釘和萬向螺釘孔都不能再次使用,,重要提示,接