raf在桡骨远端骨折的应用课件

1、桡骨远程骨折治的新进展年轻族群高能量损伤最常见骨折老年族群低能量损伤继髋关节周围骨折后第二常见骨折桡骨远程骨折50岁 男性车祸导致掌侧Barton骨折如何处理？传统骨板锁定骨板克氏针25 岁男滑倒手撑地掌侧巴顿骨折如何处理？传统骨板锁定骨板克氏针桡骨远程骨折失稳的预估患者年龄干骺端粉碎尺骨变异影像学检查下最常见关节内骨折关节内嵌入/轴向负重 骨折类型典型3骨折块1.桡骨茎突2.月状骨关节面背侧 (die punch 骨折块)3.月状骨关节面掌侧粉碎形态根据撞击角度承受能量骨品质三柱理论关节外骨折需避免骨短缩和角度丢失造成的骨不连骨块错位排列导致活动受限腕骨的应力分布改变和失稳桡腕关节炎的风险增

2、加治疗标准65岁以上(骨质疏松)关节外锁定骨板外固定+克氏针支撑固定关节内大骨块锁定骨板外固定+克氏针支撑固定锁定骨板 65岁以下(骨品质相对好)关节外掌倾20骨板石膏/骨板/外固定关节内骨板内侧块 mini螺钉固定亚洲曲率的问题男女尺寸不同必需依不同分类选择内固定器目前的困境扇形叶扇形三柱理论桡远骨折的内固定治疗和早期活动评估radial screws for the radial columnmedial screwsulnar screws for the intermediate column超过30种治疗桡骨远程骨折的骨板多中心研究报导中阐述2.4mm锁定系统骨板在治疗桡骨远程骨折时

3、的稳定性最为有效2.4mm锁定板治疗桡远骨折的管理掌侧骨板致屈肌腱断裂虽不常见却为重大的并发症骨板远程覆盖桡骨远程分水岭造成屈肌腱断裂掌侧锁定板的突出与屈肌腱断裂覆盖分水岭导致屈肌腱断裂发生率为4%屈肌腱过度摩擦导致骨板取出发生率为3%经过临床比对确认真实ML差异Anatomical Fan-Shaped Plate Design assists in restoring the original geometry of the patients anatomyStandardSmall茎突骨折茎突骨折2.4mm 三排锁钉固定桡侧柱和中间柱专利火山口 锁钉设计 完全咬合骨板 稳固锁定桡骨茎突长

4、形滑动加压孔用于调整骨板高度53O5053OChauffeurs fracture低切迹骨板和锁钉避免潜在的肌腱粘连与软组织激惹的风险圆钝形尾端设计减少软组织刺激便于微创手术植入掌倾 9 11扇形设计有助于恢复患者解剖结构男板女板三颗外仰角螺钉固定茎突病例一病例二指掌骨折多由什么引起？“The distribution of hand fractures: a british perspective” Edward Laugharne, Dhruvar Bhavsar, Vaikunthan Rajaratnam, Eur J Plast Surg 2013克氏针还是钢板内固定 “Intern

5、al fixation with the low profile plate system compared with Kirshner wire fixation: clinical results of treatment for metacarpal and phalangeal fractures” Hidetake Takigami, Hiroaki Sakano, Hand Surgery 2010骨折发生手术干预尽早康复预后佳“Management of acute fractures of the hand” , P Nithin Unnikrishnan, Vijay Bha

6、laik, Mini-symposium: Hand injuries 2014传统微型骨板强度无法满足术后康复治疗强度不锈钢锁定骨板高切迹影响术后活动度为了避免ORIF对伸肌腱的激惹“Unstable metacarpal and phalangeal fractures: treatment by internal fixation using AO mini-fragment plates and screws” Mumtaz, Farooq, Rasool, Kawoosa, Badoo, Dhar, Turkish Journal of Trauma & Emergency Surgery 2010骨板太薄并发症风险高Takigami H1, Sakano H, Saito T.Internal fixation with the low profile plate system compared with Kirschner wire fixation: clinical results of treatment for metacarpal and phalangeal fractures.Hand Surg. 2010;15(1):1-6.螺钉脱出复位丢失强度不能满足康复治疗于是百家争鸣，越做越薄2.0mm系统切迹1.2mm1.5m