强生带线锚钉在手外科的临床应用医学课件.ppt

1、强生带线锚钉强生带线锚钉(Sutue Anchor)在手外科的临床应用在手外科的临床应用强生强生(中国中国)医疗器材医疗器材有限公司有限公司 DePuy Mitek Q&AWhat?一种非常小的植入物，通过缝线将软组织和一种非常小的植入物，通过缝线将软组织和骨重新连接骨重新连接(Reattachment)。Mechanism?通过缝针将缝线穿过软组织，并打结通过缝针将缝线穿过软组织，并打结将软组织固定于锚钉上，即骨表面。将软组织固定于锚钉上，即骨表面。Material?不可吸收的钛合金或者高分子聚乙烯不可吸收的钛合金或者高分子聚乙烯;可可吸收性的多聚乳酸。吸收性的多聚乳酸。目前目前Mitek带

2、线锚钉多用于哪里带线锚钉多用于哪里?肩关节肩关节肘关节肘关节 手和腕关节手和腕关节膝关节膝关节 足和踝关节足和踝关节颌面部颌面部髋关节髋关节骨盆骨盆手外科解剖基础手外科解剖基础手手&腕骨腕骨Palmar(Volar)ViewDorsal ViewVolar PlatesCarpal BonesPhalangesProximalDistalMiddleMetacarpals3rd2nd1stEtc.RadiusUlna腕骨腕骨Palmar ViewDorsal ViewTriquetrumScaphoidLunateRadiusUlnaTriquetrumPsisiformTrapeziumCa

3、pitateHamateTrapezoidHamateCapitateArticular CartilageRemember:SLTPTTCHSLTqPTTrCH手手&腕部韧带腕部韧带Palmar(Volar)ViewDorsal ViewCollateral LigamentsUlnar Collateral LigamentSkiiers ThumbGame Keepers ThumbDeep transverse metacarpal LigamentsDorsal Intercarpal LigamentsDorsal Radiocarpal Ligament腕骨间韧带腕骨间韧带Pal

4、mar ViewScaphoidLunateTriquetrumInferior ViewScaphoidLunateTriquetrumScapholunate Ligament-Dorsal手手&腕部肌腱腕部肌腱Palmar ViewDorsal ViewFlexor TendonsFDP Repair(Flexor Digitorum Profundus)Extensor TendonsBoutonniere DeformityMallet FingerFlexor Pollicis LongusCentral SlipLateral BandsTFCC(三角纤维软骨复合体三角纤维软骨复

5、合体)Avascular regionDebridement is common hereRadiusUlnaIts the“meniscus”of the wrist!Trampoline,acts to transmit load to UlnaSkiers Thumb-拇指尺侧副韧带断裂拇指尺侧副韧带断裂Repair Using Suture AnchorsMethod of Ulnar Collateral Ligament InjuryGold Standard of RepairMost Common Use of Anchors in Hand!指深屈肌腱指深屈肌腱(aka Je

6、rsey Finger or FDP)Repair Using Suture AnchorsFlexor Digitorum Profundus Gold Standard RepairAnchors MicroMiniRecommendedFlexor Tendon lJHS,May 2019lCompares,2 Micro,1 Mini and Pullout ButtonlMax passive rehab forces at 11N(2.0lbs)lMax active motion at 19N(4.3lbs)lCompare 4.3 to our anchor strengths

7、!43.3 44.6 69.9(N)15.7 lbsButton Mini 2 Micro指伸肌腱指伸肌腱 锤状指锤状指Mallet FingerRepair using Suture Anchor指伸肌腱指伸肌腱 Boutonniere（钮扣指）钮扣指）Boutonniere DeformityRepair option using Suture Anchors指伸肌腱指伸肌腱-Swan Neck（鹅颈畸形）鹅颈畸形）Swan Neck DeformityA repair option using Suture Anchors腕部舟月韧带腕部舟月韧带ScaphoLunate repair u

8、sing Suture anchorsLunateScaphoidRadius手外科常用的带线锚钉手外科常用的带线锚钉 锚钉尺寸锚钉尺寸:1.6 x 2.7mm钻孔尺寸钻孔尺寸:1.3mm x 5.0mm(included in package)缝线缝线:3/0 Ethibond&V-4 Tapercut Needle4/0 Ethibond&C-1 Taperpoint Needle4/0 Ethibond&P-3 Precision Point Needle锚钉材料锚钉材料:PLA(tinted blue for visualization)回拉力回拉力 lbs.:8.5 lbs.in h

9、and(10.5 in clinical direction)适应症适应症:Hand:Flexor&extensor tendons PIP,DIP and MCP joints,Collateral Lig.MicroFix 锚钉锚钉MICROFIX 锚钉锚钉lKEY:只需只需 1 pound的拉力就可把锚钉固定在所的拉力就可把锚钉固定在所需位置需位置 l钻孔很重要钻孔很重要不要去皮质不要去皮质 钻头和植入手柄不要偏离轴心钻头和植入手柄不要偏离轴心l用用Micro锚钉作为备用锚钉作为备用l骨的质量不好的患者，选用金属的骨的质量不好的患者，选用金属的Micro锚钉锚钉 锚钉尺寸锚钉尺寸:1.3

10、 x 3.7mm翼展翼展:2.7mm钻孔尺寸钻孔尺寸:1.3mm x 5.0mm(included in package)缝线缝线:3/0 Ethibond&V-4 Tapercut Needle4/0 Ethibond&C-1 Taperpoint Needle4/0 Ethibond&P-3 Precision Point Needle锚钉材料锚钉材料:Titanium body with Nitinol Arcs回拉力回拉力lbs.:10 lbs.in hand适应症适应症:Hand:Flexor&extensor tendons PIP,DIP and MCP joints,Colla

11、teral Lig.Micro 锚钉锚钉锚钉已被固定锚钉已被固定向下按手柄向下按手柄植入锚钉植入锚钉操作示意图操作示意图使用中的小技巧使用中的小技巧l选择坚硬平整的接触面植入锚钉选择坚硬平整的接触面植入锚钉l在推动植入柄前，确保锚钉的鼻部在预钻的孔在推动植入柄前，确保锚钉的鼻部在预钻的孔中中l有时候手柄的滑盖不容易往后滑动，可以请手有时候手柄的滑盖不容易往后滑动，可以请手术护士预先把滑盖拉开术护士预先把滑盖拉开12的位置的位置 Micro 锚钉锚钉Mini 锚钉锚钉 锚钉尺寸锚钉尺寸:1.8 x 5.4mm翼展翼展:5.5mm钻孔尺寸钻孔尺寸:2.1mmx 9.7mm缝线缝线/缝针缝针:#0

12、Ethibond&OS-2 Reverse Cutting Needles2/0 Ethibond&V-5 Tapercut Needles锚钉材料锚钉材料:Titanium body with Nitinol Arcs回拉力回拉力lbs.:20 lbs.适应症适应症:Hand:Scapholunate,UCL,or other collateral ligamentsFoot:Mid-foot and hallux valgus l微型带线锚钉微型带线锚钉 的金标准的金标准Mini 锚钉锚钉缝针选择缝针选择强生带线锚钉的优点强生带线锚钉的优点l降低感染风险降低感染风险(&甲床破坏甲床破坏)l

13、缩短手术操作时间缩短手术操作时间 l无需行第二次手术取出内植物无需行第二次手术取出内植物 l 增加患者的舒适度增加患者的舒适度l 解剖定位更简单精确解剖定位更简单精确l降低缝线断裂的机率降低缝线断裂的机率(没有骨隧道没有骨隧道)l术后康复更简单舒适术后康复更简单舒适l锚钉预置强生锚钉预置强生Ethibond缝线缝线Miteks微型骨锚钉的应用范围微型骨锚钉的应用范围lMicro-Digits(2 if needed)lMini-Wrist&MCP Joints1 1 手腕部软组织处理手腕部软组织处理-VAPRlVAPR 小关节射频刀头小关节射频刀头l2.3mm x 85mml腕关节镜下使用腕关

14、节镜下使用l软组织清理软组织清理&热挛缩热挛缩 Side EffectWedge EffectlFlexibility of multidirectional accesslBest geometry for thermal modificationlBetter at sculptinglPrecise removal of targeted tissuelGreat for central TFCC tearslSlightly faster than wedgeTFCC-VAPR for 1A Tears Avascular regionDebridement is common her

15、eRadiusUlnaTFCCTriangular FibroCartilage ComplexIts the“meniscus”of the wrist!CUTCOAGYellowBlueElectrode Default6045Ablation35-40*45Thermal Modification516*Start here and increase gradually(if needed)KEY POINTS&PEARLS:Faster than shaversNEED good outflow in small jointUse in spurts to avoid overheatingCan use trimmed 2.3 suction sheath to improve flow and visualization