接骨板

接骨板历史沿革最新进展早期接骨板的发展1886世界上第一块有文献记载的接骨板HANSMANN1894LANE接骨板LANE1909抗腐蚀金属接骨板LAMBOTTE1948滑槽接骨板EGGERS1949第一块加压接骨板DANIS1958椭圆孔加压接骨板BAGBYUHANSMANN设计的平板接骨板U由镍、铜、锡制造而成U单皮质螺钉并且锁定于接骨板上U部分接骨板和螺钉露于体外CARLHANSMANN185319171886世界上第一块接骨板HANSMANNCEINENEUEMETHODEDERFIXIERUNGDERFRAGMENTEBEIKOMPLIZIERTENFRAKTURENVERHDTSCHGESCHIR1886151341371894LANE接骨板LANE接骨板为钢制平板螺钉为“木纹钉”（现松质骨螺钉前身）最终因接骨板的腐蚀而被放弃使用LANEWA18561943LANEWASOMEREMARKSONTHETREATMENTOFFRACTURESBMLAMBOTTE抗腐蚀金属接骨板U板横轴为弧形，和弧形骨面更贴合U螺钉为金属螺纹螺钉（现皮质钉前身）U最后因强度不够而被放弃使用ALBINLAMBOTTE18661955LAMBOTTEATECHNIQUEETINDICATIONDESPROTHSESDANSLETRAITEMENTDESFRACTURESPRESSEMED1909173211909抗腐蚀接骨板EGGERS滑槽孔接骨板螺钉可在滑槽孔滑动，防止骨折端吸收形成间隙最终因强度差和固定不稳而被淘汰EGGERSGWNINTERNALCONTACTSPLINTJBONEJOINTSURGAM1948304052GWNEGGERS189619631948滑槽孔接骨板U1949年，DANIS意识到骨块间需要加压U发明第一块加压接骨板，实现骨的一期愈合U加压理念极大地影响了后来接骨板的设计ROBERTDANIS18801962DANISRTHORIEETPRATIQUEDELOSTOSYNTHSEPARISMASSON19491949加压接骨板1958椭圆孔加压接骨板BAGBYANDJANES椭圆孔接骨板通过拧紧螺钉可实现骨折块间加压GEORGEWBAGBYBAGBYGW,JANESJMTHEEFFECTOFCOMPRESSIONONTHERATEOFFRACTUREHEALINGUSINGASPECIALPLATEAMJSURG195895761711958AO的成立MAURICEMLLER1918MARTINALLGWER19172007WALTERBANDI19121997ROBERTSCHNEIDER19121990HANSWILLENEGGER19101998AO的成立，极大地推动了骨科内固定的发展NOV6,1958,HOTELELITEBIELBIENNE,SWITZERLANDAO接骨板1961圆孔接骨板MAURICEMLLER1963管型接骨板MAURICEMLLER1965加压器MAURICEMLLER1969动力加压板STEPHANPERREN1990有限接触动力加压板STEPHANPERREN1993点状接触接骨板STEPHANPERREN1995LISSROBERTFRIGG2000锁定加压接骨板LCPROBERTFRIGG2001解剖型锁定接骨板1961AO圆孔接骨板MAURICEMLLERPRINCIPESDOSTOSYNTHSEMLLERMEHELVETICACHIRACTA1961281982061963AO管型接骨板1/2管型1/4管型1/3管型MAURICEMLLER1965年MLLER设计了通过加压器加压的接骨板开启了接骨板坚强固定骨折的时代最后被DCP替代MLLERME,ALLGWERM,WILLENEGGERHCOMPRESSIONXATIONWITHPLATESINTECHNIQUEOFINTERNALXATIONOFFRACTURESBERLINSPRINGER1965P4751MAURICEMLLER1965加压器1969动力加压板（DCP）PERRENSM,RUSSENBERGERM,STEINEMANNS,MLLERME,ALLGWERMADYNAMICCOMPRESSIONPLATEACTAORTHOPSCAND1969SUPPL1253141STEPHANPERRENMARTINALLGWER动力加压接骨板窄板DCP35宽板DCP451969动力加压板（DCP）缺陷延迟愈合板下骨丢失再骨折优点畸形愈合率低固定坚强无需外固定术后即可邻近关节活动临床疗效良好板下骨坏死应力遮挡原因STEPHANPERRENHANSUHTHOFFVS1985适度轴向微动可促进骨折愈合GOODSHIPAEGOODSHIPAE,KENWRIGHTJTHEINUENCEOFINDUCEDMICROMOVEMENTUPONTHEHEALINGOFEXPERIMENTALTIBIALFRACTURESJBONEJOINTSURGBR19856765051989动力髁螺钉DCSWALDENBERG桡骨远端接骨板桡骨远端接骨板1990重建接骨板螺孔间有很深的沟槽，容易弯曲变形强度差，可塑性好适用于复杂几何形状的骨折，如骨盆，髋臼等1990骨折生物固定软组织损伤类型决定骨折固定方式软组织损伤程度划分1轻度损伤尽可能以标准术式固定骨折2局部脱套伤间接复位固定骨折3软组织毁损伤必须行软组织重建BIOLOGICALINTERNALFIXATIONOFFRACTURESGERBERC,MASTJW,GANZRARCHORTHOPTRAUMASURG1990109295303REINHOLDGANZGERBERC1990波形接骨板主要用于治疗骨不连需植骨者防止取板出现再骨折长扇形结构避免了应力集中大大减少板断裂机会BERNHARDGEORGWEBER19272002THELIMITEDCONTACTDYNAMICCOMPRESSIONPLATELCDCPPERRENSM,KLAUEK,POHLERO,PREDIERIM,STEINEMANNS,GAUTIEREARCHORTHOPTRAUMASURG1990109304101990有限接触动力加压板STEPHANPERRENCOMPRESSIONDYNAMICPLATECONTACTLIMITEDLCDCP1993点状接触接骨板PCFIXPOINTCONTACTFIXATORSTEPHANPERRENSLOBODANTEPICBASICCONCEPTSRELEVANTTOTHEDESIGNANDDEVELOPMENTOFTHEPOINTCONTACTFIXATORPC_FIXPERRENSM,BUCHANANJSINJURY199526SUPPL214THEBIOMECHANICSOFTHEPCFIXINTERNALFIXATORTEPICS,PERRENSMINJURY199526SUPPL25101995微创固定系统（LISS）锁定头螺钉ROBERTFRIGGLISSLESSINVASIVESTABILIZATIONSYSTEMTHEDEVELOPMENTOFTHEDISTALFEMURLESSINVASIVESTABILIZATIONSYSTEMLISSFRIGGR,APPENZELLERA,CHRISTENSENRINJURY200132SUPPL324311997轴向弹性接骨板（AFP）螺钉与螺孔之间放置弹性垫只允许轴向微动较普通板愈合更快FOUXA,YEADONAJ,UHTHOFFHKIMPROVEDFRACTUREHEALINGWITHLESSRIGIDPLATESABIOMECHANICALSTUDYINDOGSCLINORTHOP199733923245弹性垫1997微创接骨板固定术（MIPO）MIPOMINIMALLYINVASIVEPLATEOSTEOSYNTHESISCHRISTIANKRETTEKHARALDTSCHERNEMINIMALLYINVASIVEPLATEOSTEOSYNTHESISMIPO,PARTIKRETTEKCEDITORINJURY199728SUPPL1A1482000锁定加压接骨板（LCP）LOCKINGCOMPRESSIONPLATELCPEINNEUERAOSTANDARDWAGNERM,FRIGGROPJOURNAL2000163238243ROBERTFRIGGMICHAELWAGNERLCPLOCKINGCOMPRESSIONPLATE尤其适用于骨质疏松者和治疗骨不连结合孔2001解剖型锁定接骨板应用微创技术的解剖型锁定接骨板2004轴向加压接骨板（ACP）BACKMAND,UHTHOFFH,POITRASP,SCHWAMBERGERAMECHANICALPERFORMANCEOFAFRACTUREPLATEINCORPORATINGBIORESORBABLEINSERTSJBONEJOINTSURGPROCEEDBR200486SUPPLIII300A螺钉B接骨板C可吸收垫L螺钉尾与骨面之间放置可吸收垫L可吸收垫为聚乳酸制成，技术尚不成熟L允许轴向微动，减少应力遮挡L有望实现骨折的生物愈合异形板微形骨板叉形板髁间异形板高尔夫球棒形骨板,重建骨板,股骨踝支持骨板肱骨髁板三叶板肱骨髁板异形板三叶形接骨板匙形骨板L形接骨板T形板肱骨髁板国内学者的研究1983梯形加压钢板葛宝丰1986新型梯形加压钢板徐莘香1989槽形对向加压钢板朱兴华1990形状记忆锯齿臂环抱器内固定器戴尅戎1992角状加压接骨板杨立民1993波形接骨板赵建宁1995应力松弛接骨板戴尅戎1995滑槽式可变应力接骨板杨继源1998组合式单层滑动接骨板霍华春1997槽型自动加压防拔钉接骨钢板白凤德1999锥状点式接触钢板李起鸿1999拱形交叉固定接骨板李福2000桥形钢板辛景义国内学者的研究2002新型点状接触动力加压接骨板赵玉峰2005自动生理加压钢板张英泽2006轨道式拱型加压接骨板金旭2007新型点接触锁定加压接骨板邢叔星2007低应力遮挡效应接骨板赖金平1983梯形加压钢板葛宝丰1986新型梯形加压