肘关节产品手术应用.ppt

肘关节产品&手术技巧,谁在做肘关节手术?,手外科医生上肢外科医生关节镜外科医生普通骨科医生,肘关节外科手术,远端二头肌腱撕裂肱骨外上髁炎（网球肘）内外侧副韧带撕裂,远端二头肌腱撕脱,BicepsTendonAttachmentSite,DistalBicepsAttachment,BicepsTendonAttachment,DistalBicepsTendon,Biceps,DistalBicepsTendonRupture,肱骨内侧髁,尺骨茎突,撕裂的二头肌腱,常见于中年男性的dominant手,BicepsTendonReattachment2IncisionTechniqueDrillHoles,BicepsTendonReattachmentSingleIncisionSutureAnchors,SutureAnchorTechnique,1incisionLessriskofinfection&lessscarringNoriskofbonetunnelbreakageEasiertoperform,savesORtime.,JHS-May2019,肱骨外上髁炎,网球肘,外上髁炎损伤&治疗,ECRB桡侧腕短伸肌的小损伤,非感染性手术治疗不常用(报道4-8%的病例用手术治疗)外科手术开放或镜下松解(shaverorRF)松解，重连接,LateralElbow,桡骨,肱骨外上髁,尺骨,LocationofECRB,ECRL桡侧腕长伸肌,ECRB桡侧腕短伸肌,ECUExtensorCarpiUlnaris尺侧腕伸肌,ECRBLocationContinued,MitekTechniqueBrochure(Dr.LorenzoWalkerCat#900091),找到ECRB松解ECRBResectLateralEpicondyle&exposerawcancelloussurfaceMobilizeExtensorOrigin用2个Mitek锚钉(GII,Fastin)重新连接到外上髁,内侧副韧带修复,TommyJohnSurgery(MedialUCL),侧副韧带修复,MedialUCLComplex,斜束,前束,后束,MedialUCL:AnteriorBandAPitchersInjury,“TommyJohnSurgery”Namedafterthefirstpatientofulnarcollateralreplacementsurgery.Doctorsname:FrankJobeFirstsurgerydonein1974,WhentheRuptureOccurs,Late-cockingAcceleration,尺侧副韧带撕裂相关问题,过头投掷运动时缺乏稳定性在做过头投掷运动时手臂不能用力过头投掷运动时不能控制,传统UCL的修复,“金标准”骨隧道技术前臂掌长肌腱或跟腱做韧带移植尺神经转置移植物8字固定韧带端用缝线缝合在一起,RepairofUCL,方法复杂，费时可用带线锚钉固定简化手术&省时减少骨隧道穿肌腱造成的创伤,AnchorsfortheElbow,AnchorBody:2.4x8.8mmArcRange:7.8mmDrillHoleSize:2.4x14.2mmSuture:#2Ethibond&CP-2ReverseCutNeedle#2Panacryl&CP-2ReverseCutNeedleAnchorMaterial:TitaniumbodywithNitinolArcsPulloutlbs.:25lbsIndications:Foot:Lateral&medialankleinstability,Mid-footreconstruction,HalluxValgus&AchilliestendonrepairElbow:TennisElbow,BicepsTendonHand:ThumbUCLandScapholunate,GIIAnchor,AnchorBody:4.1x6.0mmDrillHoleSize:3.5x18mmSuture:#2Ethibond&CP-2ReverseCutNeedle#2Panacryl&CP-2ReverseCutNeedleAnchorMaterial:PLAPulloutlbs.:35lbsIndications:Elbow:BicepstendonreattachmentAnkle:Achillestendonrepair,Lateralstabilization,Medialstabilizationatthemedialtalussite,PanalokAnchor,AnchorBody:3.0 x8.4mm4.0 x9.7mmSuture:#2Ethibond(noneedles)Drillbit:SelfdrillingAnchorMaterial:TitaniumPulloutlbs.:33.5lbs(for3.0mm),61lbs(4.0mm)Indications:Foot:Midfootreconstruction,Medialorlateralinstability,Achillestendon,Halluxv