万向锁定加压掌侧双柱接骨板治疗桡骨远端骨折

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50,Paul 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,Time,Innovation, 120 plates,VA,VA,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,A,B,C,3柱理论,成角锁定,万向锁定,为什么是“万向”：万向锁定的原理,偏离中轴15内任意方向植入螺钉四柱螺纹 + 球形螺钉头,30,+=,VA-LCP VS. LCP,LCP,VA-LCP,15,15,万向 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,万向成角的优势,适应特殊的骨折类型，抓持某些特定的骨折块螺钉定位更精准，覆盖范围更大两枚螺钉配合，可实现旋转稳定的固定,内植物,头部7孔,头部6孔,头部6孔，窄型,19.5 mm,22.0 mm,25.5 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 mm,47 - 77 mm,22 mm,7.5 mm,45 - 75 mm,19.5 mm,7.5 mm,42 - 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,Main Features / Benefits,Main Features / Benefits,1 Picture by Prof. Ladislav Nagy, Balgrist Clinic Zurich,Main Features / Benefits,Main Features / Benefits: Narrow,Features and Benefits: VA-Buttress Pin,VA-Buttress Pin 1.8 mm,工具配置: 术中选择万向或固定角锁定,产品特点,螺钉,*只成 0,*,*,支撑度：VA LCP VS. LCP,支撑度：VA LCP VS. LCP,增加了抗弯曲力,双柱的稳定性是juxtaart.接骨板的两倍！,支撑度比较,Pre-op,Post-op,Note: crossing screwsNote: scaphoid fracture and HCS 2.4,X-Ray Examples,24 year old male with AO 23C2.1 fracture,Post-op,Pre-op,Note built-in feature:Using pre-defined angles screws appear in one row in 20 inclined lateral view,20,Fall,77 year old female with AO 23C1 fracture,X-Ray Examples,Pre-op,Post-op,Note: crossing screws forming a basket to support the articular surface,82 year old female with AO 23C2 fracture,X-Ray Examples,Pre-op,Post-op,Note: 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 fracture,X-Ray Examples,Pre-op,Post-op,Note: use of K wires for preliminary fixation,Note: screws have intentionally been chosen to be far below opposite cortex,53 year old small statued female with AO 23 A3 fracture,X-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,