14强生带线锚钉在手外科的临床应用.ppt
强生带线锚钉(Sutue Anchor)在手外科的临床应用,强生(中国)医疗器材有限公司 DePuy Mitek,Q&A,What?一种非常小的植入物，通过缝线将软组织和骨重新连接(Reattachment)。Mechanism?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。Material?不可吸收的钛合金或者高分子聚乙烯;可吸收性的多聚乳酸。,目前Mitek带线锚钉多用于哪里?,肩关节肘关节 手和腕关节膝关节 足和踝关节颌面部髋关节骨盆,手外科解剖基础,手&腕骨,Palmar(Volar)View,Dorsal View,腕骨,Palmar View,Dorsal View,Triquetrum,Scaphoid,Lunate,Radius,Ulna,Triquetrum,Psisiform,Trapezium,Capitate,Hamate,Trapezoid,Hamate,Capitate,Articular Cartilage,Remember:SLTPTTCH,S,L,Tq,P,T,Tr,C,H,手&腕部韧带,Palmar(Volar)View,Dorsal View,Collateral Ligaments,Deep transverse metacarpal Ligaments,Dorsal Intercarpal Ligaments,Dorsal Radiocarpal Ligament,腕骨间韧带,Palmar View,Scaphoid,Lunate,Triquetrum,Inferior View,Scaphoid,Lunate,Triquetrum,Scapholunate Ligament-Dorsal,手&腕部肌腱,Palmar View,Dorsal View,TFCC(三角纤维软骨复合体),Avascular regionDebridement is common here,Radius,Ulna,Its the“meniscus”of the wrist!,Trampoline,acts to transmit load to Ulna,Skiers Thumb-拇指尺侧副韧带断裂,Repair Using Suture Anchors,Method of Ulnar Collateral Ligament Injury,Gold Standard of Repair,Most Common Use of Anchors in Hand!,指深屈肌腱(aka Jersey Finger or FDP),Repair Using Suture Anchors,Flexor Digitorum Profundus,Gold Standard Repair,Anchors,Micro,Mini,Recommended,Flexor Tendon,JHS,May 2001Compares,2 Micro,1 Mini and Pullout ButtonMax passive rehab forces at 11N(2.0lbs)Max active motion at 19N(4.3lbs)Compare 4.3 to our anchor strengths!,43.3 44.6 69.9(N)15.7 lbs,Button Mini 2 Micro,指伸肌腱 锤状指,Mallet Finger,Repair using Suture Anchor,指伸肌腱 Boutonniere（钮扣指）,Boutonniere Deformity,Repair option using Suture Anchors,指伸肌腱-Swan Neck（鹅颈畸形）,Swan Neck Deformity,A repair option using Suture Anchors,腕部舟月韧带,ScaphoLunate repair using Suture anchors,Lunate,Scaphoid,Radius,手外科常用的带线锚钉,锚钉尺寸:1.6 x 2.7mm钻孔尺寸:1.3mm x 5.0mm(included in package)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:PLA(tinted blue for visualization)回拉力 lbs.:8.5 lbs.in hand(10.5 in clinical direction)适应症:Hand:Flexor&extensor tendons PIP,DIP and MCP joints,Collateral Lig.,MicroFix 锚钉,MICROFIX 锚钉,KEY:只需 1 pound的拉力就可把锚钉固定在所需位置 钻孔很重要不要去皮质 钻头和植入手柄不要偏离轴心用Micro锚钉作为备用骨的质量不好的患者，选用金属的Micro锚钉,锚钉尺寸:1.3 x 3.7mm翼展:2.7mm钻孔尺寸:1.3mm x 5.0mm(included in package)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:Titanium body with Nitinol Arcs回拉力lbs.:10 lbs.in hand适应症:Hand:Flexor&extensor tendons PIP,DIP and MCP joints,Collateral Lig.,Micro 锚钉,锚钉已被固定,向下按手柄植入锚钉,操作示意图,使用中的小技巧,选择坚硬平整的接触面植入锚钉在推动植入柄前，确保锚钉的鼻部在预钻的孔中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12的位置,Micro 锚钉,Mini 锚钉,锚钉尺寸:1.8 x 5.4mm翼展:5.5mm钻孔尺寸:2.1mmx 9.7mm缝线/缝针:#0 Ethibond&OS-2 Reverse Cutting Needles2/0 Ethibond&V-5 Tapercut Needles锚钉材料:Titanium body with Nitinol Arcs回拉力lbs.:20 lbs.适应症:Hand:Scapholunate,UCL,or other collateral ligamentsFoot:Mid-foot and hallux valgus,微型带线锚钉 的金标准,Mini 锚钉,缝针选择,强生带线锚钉的优点,降低感染风险(&甲床破坏)缩短手术操作时间 无需行第二次手术取出内植物 增加患者的舒适度 解剖定位更简单精确降低缝线断裂的机率(没有骨隧道)术后康复更简单舒适锚钉预置强生Ethibond缝线,Miteks微型骨锚钉的应用范围,Micro-Digits(2 if needed)Mini-Wrist&MCP Joints,手腕部软组织处理-VAPR,VAPR 小关节射频刀头2.3mm x 85mm腕关节镜下使用软组织清理&热挛缩,Side Effect,Wedge Effect,Flexibility of multidirectional accessBest geometry for thermal modificationBetter at sculpting,Precise removal of targeted tissueGreat for central TFCC tearsSlightly faster than wedge,TFCC-VAPR for 1A Tears,Avascular regionDebridement is common here,Radius,Ulna,TFCCTriangular FibroCartilage Complex,Its the“meniscus”of the wrist!,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,
