半月板缝合系统.ppt

Mitek半月板修复系统,AnatomyProductoverviewInstructionsforuseHands-onworkshop,Agenda,MeniscalfunctionLoadtransmission负荷转移Jointstability稳定关节Shockabsorption振荡吸收Jointlubrication润滑关节Jointnutrition营养关节,Anatomy,Crescent-shapedfibrocartilage新月形纤维软骨组织Collagenfibersarranged胶原纤维分布longitudinallyandradially纵形放射状分布Triangularincrosssection横切面呈三角型,MeniscalAnatomy,Lateral-circularshapedMedial-C-shapedConnectedanteriorlybytransversemeniscalligament在前部由半月板横韧带连接Directbonyattachmentsatanteriorandposteriorhorns前后角骨性连接Lateralandmedialcoronaryligaments内外侧有冠状韧带,Lateral,Medial,MeniscalAnatomy,Anatomy,ThreeZonesRed-RedZoneRed-WhiteZoneWhite-WhiteZone,MeniscalBloodSupply,LocationinrelationshiptocircumferenceAnterior1/3Middle1/3Posterior1/3,ClassificationofTears,TRAUMATIC创伤性-Youngerpatients-Usuallysportsrelated-Moreperipheralthusrepairable外围可以修补-MaybeassociatedwithACL,DEGENERATIVE变性性-Olderpatients-Complextears-Usuallynotrepairable-Agegrouptypicallynotsuitedforrepair,MeniscalTears,Treatment,PartialMenisectomyComplexdegenerativetears复杂变性撕裂。Centralorradialtears放射状撕裂Deformedorirreparablebucket-handletears严重桶状裂Tearsoftheinneredgeofmeniscus半月板内缘撕裂Preservestablemeniscustopreservejointfunction,Treatment-Repair,Factorstoconsider因素Patientage年龄Chronicityofinjury是否慢性损伤Type,locationandlengthoftear类型、位置、长度Associatedligamentousinjuries联合损伤Idealcandidate理想条件Youngperson年轻Acutelongitudinalperipheraltear急性纵相外周损伤1-2cminlength1-2cm长,TypesofTears,Buckethandle/verticallongitudinalFlap,parrotbeak/obliqueRadial/transverse,TypesofTears,Cleavage/horizontalDegenerative/complex,WhatIsIt?,RapidlocMeniscalRepairSystem,Backstop(PLA),Tophat(PLA/PDS),Panacryl/EthibondSuture,RapidlocImplant,RapidLocPDS,PDSTophatMaintains80%strengthat6weeks10%at12weeks,RapidlocMeniscalRepairSystem,27curvedneedle22832212curvedneedle228321Straightneedle228320,RapidlocMeniscalRepairSystem,ArthroscopicPusherRequired-Otherpushersdonotwork.,NewPusher-Cutter,ArthroscopicPusher-CutterforRapidLocWorksasaKnot-PusherCutssutureaftertophatiscompressedtotissue,RapidlocMeniscalRepairSystem,DeliverySystem,ExistingMeniscalApplierLessKickback,SurgicalTechnique,RapidlocSurgicalTechnique,Indicatedforbucket-handlelesionsintheVascularizedareasofthemeniscus.桶状裂PreparationoftheteariscriticalFreshenthetearwitharasporshaver.修整创伤面,RapidlocSurgicalTechnique,Inserttheapplierthroughastandardportal通过标准入路插入填充琦ThroughportalaloneThroughacannulaWiththeaidofthemalleablegraftretractor,RapidlocSurgicalTechnique,Useneedleandsiliconetubingtoreducethetear,RapidlocSurgicalTechnique,PasstheneedlethroughtheMeniscalsubstanceandintothePericapsulartissuePosteriorly.将针穿过半月板穿到关节囊后,RapidlocSurgicalTechnique,Deploythebackstop展开挡板Maintainpressureontheguntopreventkickback保持压力Removeneedleandapplierfromjoint撤出针及枪,RapidlocSurgicalTechnique,Pullonthelimbofsuturetoassurecaptureandfixationofthebackstop推线确保固定牢靠,RapidlocSurgicalTechnique,UsingtheArthroscopicpusherslidetheknotandTophatdowntothesurfaceofthetissue用推结器将结推到半月板Useapull/pushactionPullonthesuturewithslightlymoretensiontoavoidslackinthesuture,RapidlocSurgicalTechnique,Cutthelimbofsuture剪线Repeatwithadditionalimplants相同方法植入Probetoassuretearisstable探钩确认固定牢靠,Rapidloc,WhyisitBetter?,WhyIsItBetter?,FlexibilityMorechoicesforthesurgeonNomeasuring/nofixedlengthOneimplantDependablecompressionControlledbysu