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 Rapidloc MeniscalRepairSystem Backstop PLA Tophat PLA PDS Panacryl EthibondSuture Rapidloc Implant RapidLocPDS PDSTophatMaintains80 strengthat6weeks10 at12weeks Rapidloc MeniscalRepairSystem 27 curvedneedle22832212 curvedneedle228321Straightneedle228320 Rapidloc MeniscalRepairSystem ArthroscopicPusherRequired Otherpushersdonotwork NewPusher Cutter ArthroscopicPusher CutterforRapidLocWorksasaKnot PusherCutssutureaftertophatiscompressedtotissue Rapidloc MeniscalRepairSystem DeliverySystem ExistingMeniscalApplierLessKickback SurgicalTechnique Rapidloc SurgicalTechnique Indicatedforbucket handlelesionsintheVascularizedareasofthemeniscus 桶状裂PreparationoftheteariscriticalFreshenthetearwitharasporshaver 修整创伤面 Rapidloc SurgicalTechnique Inserttheapplierthroughastandardportal通过标准入路插入填充琦ThroughportalaloneThroughacannulaWiththeaidofthemalleablegraftretractor Rapidloc SurgicalTechnique Useneedleandsiliconetubingtoreducethetear Rapidloc SurgicalTechnique PasstheneedlethroughtheMeniscalsubstanceandintothePericapsulartissuePosteriorly 将针穿过半月板穿到关节囊后 Rapidloc SurgicalTechnique Deploythebackstop展开挡板Maintainpressureontheguntopreventkickback保持压力Removeneedleandapplierfromjoint撤出针及枪 Rapidloc SurgicalTechnique Pullonthelimbofsuturetoassurecaptureandfixationofthebackstop推线确保固定牢靠 Rapidloc SurgicalTechnique UsingtheArthroscopicpusherslidetheknotandTophatdowntothesurfaceofthetissue用推结器将结推到半月板Useapull pushactionPullonthesuturewithslightlymoretensiontoavoidslackinthesuture Rapidloc SurgicalTechnique Cutthelimbofsuture剪线Repeatwithadditionalimplants相同方法植入Probetoassuretearisstable探钩确认固定牢靠 Rapidloc WhyisitBetter WhyIsItBetter FlexibilityMorechoicesforthesurgeonNomeasuring nofixedlengthOneimplantDependablecompressionControlledbysurgeon WhyIsItBetter Flexiblefixation柔