萬(wàn)向鎖定加壓掌側(cè)雙柱接骨板治療橈骨遠(yuǎn)端骨折

1、萬(wàn)向鎖定加壓掌側(cè)雙柱接骨板萬(wàn)向鎖定加壓掌側(cè)雙柱接骨板2.42.4橈骨遠(yuǎn)端骨折橈骨遠(yuǎn)端骨折n 最常最常見(jiàn)見(jiàn)的骨折，沒(méi)有之一的骨折，沒(méi)有之一 (15%(15%）n 80%: 80%: 老年女性老年女性 (60(60歲歲以上以上) )n 預(yù)計(jì)預(yù)計(jì)至至20302030年增加到年增加到5050Paul W. Thompson et al: The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in Dorset, UK, Injury Vol

2、ume 35, Issue 5, p.462-466, May 2004 TimeInnovation200820052009200319962001 120 platesVAVA萬(wàn)向鎖定加壓掌側(cè)雙柱接骨板萬(wàn)向鎖定加壓掌側(cè)雙柱接骨板2.42.4n 橈橈骨骨遠(yuǎn)遠(yuǎn)端關(guān)端關(guān)節(jié)節(jié)內(nèi)或關(guān)內(nèi)或關(guān)節(jié)節(jié)外的骨折，以及截骨后的固定外的骨折，以及截骨后的固定為什么是為什么是“雙柱雙柱”：三柱理論：三柱理論尺側(cè)柱中間柱和橈側(cè)柱尺骨遠(yuǎn)端背側(cè)掌側(cè)單行螺釘掌側(cè)多行螺釘ABC3柱理論柱理論成角鎖定萬(wàn)向鎖定為什么是為什么是“萬(wàn)向萬(wàn)向”：萬(wàn)向鎖定的原理：萬(wàn)向鎖定的原理n 偏離中偏離中軸軸1515內(nèi)任意方向植入螺內(nèi)任意方向植入螺

3、釘釘n 四柱四柱螺螺紋紋 + + 球形螺球形螺釘頭釘頭30+=VA-LCP VS. LCPVA-LCP VS. LCPLCP VA-LCP1515萬(wàn)向萬(wàn)向 VS. VS. 標(biāo)準(zhǔn)鎖定螺釘標(biāo)準(zhǔn)鎖定螺釘錐形螺釘頭錐形螺釘頭圓形螺釘頭圓形螺釘頭標(biāo)準(zhǔn)鎖定螺釘標(biāo)準(zhǔn)鎖定螺釘萬(wàn)向鎖定螺釘萬(wàn)向鎖定螺釘萬(wàn)向成角的優(yōu)勢(shì)萬(wàn)向成角的優(yōu)勢(shì)n 適適應(yīng)應(yīng)特殊的骨折特殊的骨折類(lèi)類(lèi)型，抓持某些特定的骨折型，抓持某些特定的骨折塊塊n 螺螺釘釘定位更精準(zhǔn)，覆蓋范定位更精準(zhǔn)，覆蓋范圍圍更大更大n 兩枚螺兩枚螺釘釘配合，可配合，可實(shí)現(xiàn)實(shí)現(xiàn)旋旋轉(zhuǎn)穩(wěn)轉(zhuǎn)穩(wěn)定的固定定的固定內(nèi)植物內(nèi)植物頭部頭部7孔孔頭部頭部6孔孔頭部頭部6孔，窄型孔，窄型19.

4、5 mm22.0 mm25.5 mm寬度寬度內(nèi)植物內(nèi)植物25.5 mm 頭部頭部7孔孔 頭部頭部6孔孔 頭部頭部6孔孔 ，窄型7.5 mm47 - 77 mm22 mm7.5 mm45 - 75 mm19.5 mm7.5 mm42 - 72 mm即使不采用萬(wàn)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(duì)大多數(shù)基本的骨折類(lèi)型骨折類(lèi)型多種多樣，在固定角鎖定無(wú)法處理的時(shí)候，可采用萬(wàn)向成角鎖定預(yù)設(shè)角鎖定的螺釘排列預(yù)設(shè)角鎖定的螺釘排列萬(wàn)向鎖定萬(wàn)向鎖定FeaturesBenefitsVariable AngleVariable AngleUp to 15Up to 15 off-axis screw of

5、f-axis screw angulation in order to angulation in order to address address the individual fracture the individual fracture patterns patterns Better support of lunate facet and DRUJProper fixation of radial styloidPossibility of new-positioning Possibility of new-positioning of screwof screwRotation

6、stable fixation of Rotation stable fixation of fragments (with 2 screws)fragments (with 2 screws)Kirschner Wire Kirschner Wire holesholesPreliminary plate fixation Preliminary plate fixation with Kirschner Wires or Plate with Kirschner Wires or Plate Reduction WiresReduction WiresOblong LCP Oblong L

7、CP combi-holecombi-holeAllows accurate plate Allows accurate plate positioning on the bonepositioning on the boneMain Features / BenefitsMain Features / BenefitsFeaturesBenefitsRounded edges, Rounded edges, polished surface polished surface and and countersunk countersunk screwsscrewsReduced risk of

8、 soft tissue Reduced risk of soft tissue irritationsirritationsAnatomically Anatomically pre-contouredpre-contouredPlate sits very close to volar Plate sits very close to volar ridge on the ulnar side to ridge on the ulnar side to achieve optimal support of the achieve optimal support of the lunate

9、facetlunate facetTwo-Column Two-Column designdesign1 1Window helps to see fracture Window helps to see fracture lineslinesWindow allows bone graft Window allows bone graft insertioninsertionMain Features / BenefitsMain Features / Benefits1 Picture by Prof. Ladislav Nagy, Balgrist Clinic ZurichFeatur

10、esBenefitsTrial ImplantsTrial ImplantsPlate dimension Plate dimension determination for sterile users determination for sterile users Guiding Block / Guiding Block / Quick drill Quick drill sleevesleeveAllows guided drilling and Allows guided drilling and screw insertion in the pre-screw insertion i

11、n the pre-defined nominal angledefined nominal angleMain Features / BenefitsMain Features / BenefitsFeaturesBenefitsRounded Rounded corners on corners on radial and ulnar radial and ulnar edges to fit into edges to fit into smaller areasmaller areaFor treatment of small-For treatment of small-statur

12、ed patientsstatured patientsAllows a more minimally Allows a more minimally invasive approach of patients invasive approach of patients with simple fractureswith simple fracturesAdapted Adapted anatomical anatomical shapeshapeEspecially designed for Especially designed for smaller radiismaller radii

13、Distal angulation lowered Distal angulation lowered from 25from 25 2020 for fit on for fit on small radiismall radiiPlate sits very close to volar Plate sits very close to volar ridge on the ulnar side to ridge on the ulnar side to achieve optimal support of the achieve optimal support of the lunate

14、 facetlunate facetMain Features / Main Features / BenefitsBenefits: Narrow: NarrowFeatures and Benefits: VA-Buttress PinFeatures and Benefits: VA-Buttress PinFeaturesBenefitsVA Locking VA Locking Head with T8 Head with T8 Stardrive Stardrive RecessRecessUp to 15Up to 15 off-axis screw off-axis screw

15、 angulation angulation in any VA Locking in any VA Locking HoleHole2.4mm2.4mm neck neck threadsthreadsBacks pin out for easy Backs pin out for easy removalremovalSmooth Smooth 1.8mm shaft1.8mm shaftEasy and quick insertionEasy and quick insertionProvides buttressing for Provides buttressing for comp

16、lex comminuted fracturescomplex comminuted fracturesRounded TipRounded TipReduces the risk of tendon Reduces the risk of tendon irritationsirritationsVA-Buttress Pin 1.8 mm工具配置工具配置: : 術(shù)中選擇萬(wàn)向或固定角鎖定術(shù)中選擇萬(wàn)向或固定角鎖定015特點(diǎn)優(yōu)勢(shì)導(dǎo)向模塊導(dǎo)向模塊n節(jié)省時(shí)間節(jié)省時(shí)間n便于植入成角鎖定螺釘便于植入成角鎖定螺釘便捷套筒便捷套筒n前端沒(méi)有螺紋，便于插入前端沒(méi)有螺紋，便于插入n鉆孔，測(cè)深一步完成鉆孔，測(cè)深一

17、步完成測(cè)深器測(cè)深器n易于抓持，測(cè)量易于抓持，測(cè)量n便于清潔便于清潔產(chǎn)品特點(diǎn)產(chǎn)品特點(diǎn)萬(wàn)向鎖定孔萬(wàn)向鎖定孔 LCP LCP 結(jié)合孔結(jié)合孔萬(wàn)向鎖定螺釘萬(wàn)向鎖定螺釘 2.4mm2.4mm標(biāo)準(zhǔn)鎖定螺釘標(biāo)準(zhǔn)鎖定螺釘 2.4mm2.4mm皮質(zhì)螺釘皮質(zhì)螺釘 2.4mm2.4mm皮質(zhì)螺釘皮質(zhì)螺釘 2.7mm 2.7mm螺釘螺釘 *只成只成 0*支撐度支撐度：VA LCP VA LCP VS.VS. LCP LCP支撐度：支撐度：VA LCP VS. LCPVA LCP VS. LCP增加了抗彎曲力增加了抗彎曲力雙柱的穩(wěn)定性是雙柱的穩(wěn)定性是juxtaart.juxtaart.接接骨板的兩倍！骨板的兩倍！Fixed

18、Force支撐度比較支撐度比較Pre-opPost-opNote: crossing screwsNote: scaphoid fracture and HCS 2.4X-Ray ExamplesX-Ray Examples24 year old male with AO 23C2.1 fracture24 year old male with AO 23C2.1 fracturePost-opPre-opNote built-in feature:Using pre-defined angles screws appear in one row in 20 inclined lateral

19、view20Fall77 year old female with AO 23C1 fracture77 year old female with AO 23C1 fractureX-Ray ExamplesX-Ray ExamplesPre-opPost-opNote: crossing screws forming a basket to support the articular surface82 year old female with AO 23C2 fracture82 year old female with AO 23C2 fractureX-Ray ExamplesX-Ra

20、y ExamplesPre-opPost-opNote: very distal angulation of styloid screw (in this case it is a 2.4 cortex, works also with VA-LCP).75 year old female with AO 23A3 fracture75 year old female with AO 23A3 fractureX-Ray ExamplesX-Ray ExamplesPre-opPost-opNote: use of K wires for preliminary fixationNote: s

21、crews have intentionally been chosen to be far below opposite cortex53 year old small statued female with AO 23 A3 53 year old small statued female with AO 23 A3 fracturefractureX-Ray ExamplesX-Ray Examplesn掌側(cè)入路掌側(cè)入路手術(shù)操作要點(diǎn)手術(shù)操作要點(diǎn)n復(fù)位骨折塊復(fù)位骨折塊n放置接骨板放置接骨板n在在LCPLCP加長(zhǎng)孔植入皮質(zhì)螺釘加長(zhǎng)孔植入皮質(zhì)螺釘2.4 mm或2.7 mm手術(shù)操作要點(diǎn)手術(shù)操作要

22、點(diǎn)n可使用可使用1.25 mm1.25 mm克氏針克氏針n螺釘和克氏針植入的順螺釘和克氏針植入的順序由骨折類(lèi)型決定序由骨折類(lèi)型決定手術(shù)操作要點(diǎn)手術(shù)操作要點(diǎn)n鉆萬(wàn)向鎖定螺釘孔鉆萬(wàn)向鎖定螺釘孔萬(wàn)向LCP導(dǎo)鉆嵌入嵌入萬(wàn)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)手術(shù)操作要點(diǎn)n固定成角導(dǎo)鉆固定成角導(dǎo)鉆n可以解決可以解決80%80%的骨折類(lèi)型的骨折類(lèi)型 Note: 帶螺紋的帶螺紋的LCP導(dǎo)鉆不適用導(dǎo)鉆不適用固定成角螺釘：方法一固定成角螺釘：方法一手術(shù)操作要點(diǎn)手術(shù)操作要點(diǎn)n導(dǎo)向模塊結(jié)合快速導(dǎo)鉆導(dǎo)向模塊結(jié)合快速導(dǎo)鉆固定成角螺釘：方法二固定成角螺釘：方法二手術(shù)操作要點(diǎn)手術(shù)操作要點(diǎn)n在遠(yuǎn)端植入萬(wàn)向鎖定螺釘在遠(yuǎn)端植入萬(wàn)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)手術(shù)操作要點(diǎn)