强生带线锚钉在手外科的临床应用医学课件.ppt

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1、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,强生带线锚钉(Sutue Anchor)在手外科的临床应用,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。,Q & AWhat? 一种非常小的植入物，通过缝线将软,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,目前Mi

2、tek带线锚钉多用于哪里?,强生带线锚钉在手外科的临床应用医学课件,手外科解剖基础,手外科解剖基础,手& 腕骨,Palmar (Volar) View,Dorsal View,手& 腕骨Palmar (Volar) ViewDorsa,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,

3、Tq,P,T,Tr,C,H,腕骨Palmar ViewDorsal ViewTriqu,手& 腕部韧带,Palmar (Volar) View,Dorsal View,Collateral Ligaments,Deep transverse metacarpal Ligaments,Dorsal Intercarpal Ligaments,Dorsal Radiocarpal Ligament,手& 腕部韧带Palmar (Volar) ViewDors,腕骨间韧带,Palmar View,Scaphoid,Lunate,Triquetrum,Inferior View,Scaphoid,Lu

4、nate,Triquetrum,Scapholunate Ligament- Dorsal,腕骨间韧带Palmar ViewScaphoidLunat,手& 腕部肌腱,Palmar View,Dorsal View,Flexor Pollicis Longus,Central SlipLateral Bands,手& 腕部肌腱Palmar ViewDorsal View,TFCC (三角纤维软骨复合体),Avascular regionDebridement is common here,Radius,Ulna,Its the “meniscus” of the wrist!,Trampoli

5、ne, acts to transmit load to Ulna,TFCC (三角纤维软骨复合体)Avascular regi,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!,Skiers Thumb- 拇指尺侧副韧带断裂Repai,指深屈肌腱(aka Jersey Finger or FDP),Repair Using Suture

6、 Anchors,Flexor Digitorum Profundus,Gold Standard Repair,Anchors,Micro,Mini,Recommended,指深屈肌腱(aka Jersey Finger or FD,Flexor Tendon,JHS, May 2019Compares, 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!,4

7、3.3 44.6 69.9 (N) 15.7 lbs,Button Mini 2 Micro,Flexor Tendon JHS, May 201943.,指伸肌腱 锤状指,Mallet Finger,Repair using Suture Anchor,指伸肌腱 锤状指Mallet FingerRepai,指伸肌腱 Boutonniere（钮扣指）,Boutonniere Deformity,Repair option using Suture Anchors,指伸肌腱 Boutonniere（钮扣指）Boutonn,指伸肌腱 - Swan Neck（鹅颈畸形）,Swan Neck Defo

8、rmity,A repair option using Suture Anchors,指伸肌腱 - Swan Neck（鹅颈畸形）Swan Ne,腕部舟月韧带,ScaphoLunate repair using Suture anchors,Lunate,Scaphoid,Radius,腕部舟月韧带ScaphoLunate repair usi,手外科常用的带线锚钉,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 Ethib

9、ond & 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,锚钉尺寸: 1.6 x 2.7m,MICROFIX 锚钉,KEY: 只需 1 pound的拉力

10、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,MICROFIX 锚钉KEY: 只需 1 pound的拉力就,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 bo

11、dy 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,锚钉尺寸: 1.3 x 3.7,锚钉已被固定,向下按手柄植入锚钉,操作示意图,锚钉已被固定向下按手柄操作示意图,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,使用中的小技巧选择坚硬平整的接触面植入锚钉,Micro 锚钉,Micro

12、 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,Mini 锚钉 锚钉尺寸: 1.,微

13、型带线锚钉 的金标准,Mini 锚钉,微型带线锚钉Mini 锚钉,缝针选择,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,强生带线锚钉的优点降低感染风险 (& 甲床破坏),Miteks微型骨锚钉的应用范围,Micro- Digits (2 if needed)Mini - Wrist & MCP Joints,Miteks微型骨锚钉的应用范围,1 1 ,强生带线锚钉在手外科的临床应用医学课件,手腕部软组织处理- V

14、APR,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,手腕部软组织处理- VAPRVAPR 小关节射频刀头 Sid,强生带线锚钉在手外科的临

15、床应用医学课件,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,TFCC- VAPR for 1A Tears Avascu,谢谢！,谢谢！,