锚钉在创伤骨科应用

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4、evel,,,,*,Click to edit Master title style,,Click to edit Master text styles,,Second level,,Third level,,Fourth level,,,,*,Click to edit Master title style,,Click to edit Master text styles,,Second level,,Third level,,Fourth level,,*,,*,,带线锚钉的临床应用,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

5、镜外科医生,,矫形外科医生,,足踝外科医生,施乐辉,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,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,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,针对不同的肌腱或韧带损伤,,锚钉的应用,施乐辉,,肩关节关节周

6、围损伤的应用,施乐辉,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,,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,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,,

7、,,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,,Humeral Head,,施乐辉,Bankart,损伤,,SLAP,损伤,,施乐辉,肩盂唇修复锚钉的选择,,TwinFix Ti 2.8,、,3.5mm,,Bioraptor 2.9mm,,,PEEK,材料选择,,肘关节周围损伤的应用,施乐辉,,,,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,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

8、,肱二头肌腱远端断裂锚钉修复（单切口）,,施乐辉,Suture Anchor Technique,1 incision…Less risk of infection & less scarring,,No risk of bone tunnel breakage,,Easier to perform, saves OR time.,施乐辉,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,,Location of ECRB

9、,,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,ECRB Location Continued,,施乐辉,,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,,侧副韧带修复,,,Medial UCL Complex,斜束,前束,后束,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,,在做过头投掷运动时手臂

10、不能用力,,过头投掷运动时不能控制,,,,施乐辉,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,,膝关节周围损伤的应用,施乐辉,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,,,,,,,,,,,膝,,施乐辉,,足踝关节周围损伤的应用,施乐辉,施乐辉,选择锚钉,-,足,/,踝

11、,,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,,,,,,,拇外翻,,施乐辉,Lateral Ankle Instability,–,Ligaments Affected,,,距腓前,,韧带,跟腓韧带,Most commonly injured,施乐辉,踝关节外侧不稳定,,ATF Repair,施乐辉,外侧踝关节不稳定,–,基本修复,,施乐辉,踝关节外侧不稳定 –,Secondary

12、 Repair,用于慢性不稳定,,用腓骨短肌腱的前,½,,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,跟腱修复,Split, Rupture & Haglund,’,s Deformity,,Tendo Calcaneous,(Achilles Tendon),施乐辉,跟腱断裂,,施乐辉,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,,手部韧带肌腱损伤的应用,施乐辉,,,舟月骨

13、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,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,,指深屈肌腱(,aka Jersey Finger or FDP),,,Gold Standard Repair,,,Anchors…,,Recommended,施乐辉,指伸肌腱,–,锤状指,,,,Mallet Finger,,,Repair using Suture Anchor,施乐

14、辉,指伸肌腱 –,Boutonniere（,钮扣指）,,,Boutonniere Deformity,,Repair option using Suture Anchors,施乐辉,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,,锚钉植入操作步骤,&,技巧,施乐辉,锚钉操作步骤一,,,,,,,,,打磨骨面，致粗糙渗血,,,,,,,,施乐辉,锚钉操作步骤二,,,,,植入锚钉，位于皮质骨,2-3mm,处,施乐辉,锚钉操作步骤三,,,,,,,,,将缝线打结，使肌腱固 定于骨面上,,,施乐辉,

15、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,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,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,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,TwinFix,锚钉产品线,施乐辉,,,谢 谢,广州中医药大学第一附属医院,