万向锁定加压掌侧双柱接骨板治疗桡骨远端骨折课件

1、万向锁定加压掌侧双柱接骨板2.4桡骨远端骨折最常见的骨折，没有之一 (15%） 80%: 老年女性 (60岁以上)预计至2030年增加到50Paul 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 Volume 35, Issue 5, p.462-466, May 2004 TimeInnovation200820052009200319962

2、001 120 platesVAVA万向锁定加压掌侧双柱接骨板2.4桡骨远端关节内或关节外的骨折，以及截骨后的固定为什么是“双柱”：三柱理论尺侧柱中间柱和桡侧柱尺骨远端背侧掌侧单行螺钉掌侧多行螺钉ABC3柱理论成角锁定万向锁定VA-LCP VS. LCPLCP VA-LCP1515万向 VS. 标准锁定螺钉锥形螺钉头圆形螺钉头标准锁定螺钉万向锁定螺钉内植物头部7孔头部6孔头部6孔，窄型19.5 mm22.0 mm25.5 mm宽度内植物25.5 mm 头部7孔 头部6孔 头部6孔 ，窄型7.5 mm47 - 77 mm22 mm7.5 mm45 - 75 mm19.5 mm7.5 mm42 -

3、 72 mm即使不采用万向成角锁定，钉孔的排列和预设角度也已经可以应对大多数基本的骨折类型骨折类型多种多样，在固定角锁定无法处理的时候，可采用万向成角锁定预设角锁定的螺钉排列万向锁定FeaturesBenefitsRounded edges, polished surface and countersunk screwsReduced risk of soft tissue irritationsAnatomically pre-contouredPlate sits very close to volar ridge on the ulnar side to achieve optimal

4、support of the lunate facetTwo-Column design1Window helps to see fracture linesWindow allows bone graft insertionMain Features / Benefits1 Picture by Prof. Ladislav Nagy, Balgrist Clinic ZurichFeaturesBenefitsTrial ImplantsPlate dimension determination for sterile users Guiding Block / Quick drill s

5、leeveAllows guided drilling and screw insertion in the pre-defined nominal angleMain Features / BenefitsFeatures and Benefits: VA-Buttress PinFeaturesBenefitsVA Locking Head with T8 Stardrive RecessUp to 15 off-axis screw angulation in any VA Locking Hole2.4mm neck threadsBacks pin out for easy remo

6、valSmooth 1.8mm shaftEasy and quick insertionProvides buttressing for complex comminuted fracturesRounded TipReduces the risk of tendon irritationsVA-Buttress Pin 1.8 mm工具配置: 术中选择万向或固定角锁定015特点优势导向模块节省时间便于植入成角锁定螺钉便捷套筒前端没有螺纹，便于插入钻孔，测深一步完成测深器易于抓持，测量便于清洁产品特点万向锁定孔LCP 结合孔万向锁定螺钉 2.4mm标准锁定螺钉 2.4mm皮质螺钉 2.4mm

7、皮质螺钉 2.7mm螺钉 *只成 0*支撑度：VA LCP VS. LCP支撑度：VA LCP VS. LCPPre-opPost-opNote: crossing screwsNote: scaphoid fracture and HCS 2.4X-Ray Examples24 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 view20Fall77 y

8、ear old female with AO 23C1 fractureX-Ray 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 fractureX-Ray ExamplesPre-opPost-opNote: use of K wires for preliminary fixationNote: screws have int

9、entionally been chosen to be far below opposite cortex53 year old small statued female with AO 23 A3 fractureX-Ray Examples掌侧入路手术操作要点复位骨折块放置接骨板在LCP加长孔植入皮质螺钉2.4 mm或2.7 mm手术操作要点可使用1.25 mm克氏针螺钉和克氏针植入的顺序由骨折类型决定手术操作要点钻万向锁定螺钉孔万向LCP导钻嵌入万向锁定螺钉孔内确认嵌入后钻孔30手术操作要点固定成角导钻可以解决80%的骨折类型 Note: 带螺纹的LCP导钻不适用固定成角螺钉：方法一手

10、术操作要点导向模块结合快速导钻固定成角螺钉：方法二手术操作要点在远端植入万向锁定螺钉 确认螺钉到达理想位置后，再进行最后的锁紧步骤手术操作要点0.8Nm扭力限制扳手在执行最后锁紧螺钉步骤以后， 不能再此重新植入螺钉螺钉锁定手术操作要点使用C-arm最后鉴别螺钉位置关闭切口重要信息：由于解剖预塑型，螺钉中立位固定后将向远段成角20，需要在Carm下控制， 以免穿入关节腔20 向外倾斜侧位片4枚螺钉螺钉投射成一线手术操作要点螺钉在没有锁定的情况下， 如果角度不理想，可最多从万向螺钉孔里取出3次；完成锁定后，该万向锁定螺钉和万向螺钉孔都不能再次使用重要提示接骨板已预塑形如有必要，可适当折弯（如图）如果计划使用导向模块，则应避免折弯手术操作要点临床病例术后前后位术前前后位 术前侧位77岁女性，AO 23C1骨折， 跌倒Fall术后：侧位，20倾斜20本病例治疗中未使用万向成角螺钉，可见预设的螺钉方向处于同一平面，与冠状面成20度角总结特点好处对医生的益处锁