1、万向锁定加压掌侧双柱接骨板万向锁定加压掌侧双柱接骨板2.42.4桡骨远端骨折桡骨远端骨折n最常最常见见的骨折，没有之一的骨折，没有之一(15%）n 80%:老年女性老年女性(60岁岁以上以上)n预计预计至至2030年增加到年增加到50Paul 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
2、2004 TimeInnovation200820052009200319962001 120 platesVAVA万向锁定加压掌侧双柱接骨板万向锁定加压掌侧双柱接骨板2.4n桡桡骨骨远远端关端关节节内或关内或关节节外的骨折，以及截骨后的固定外的骨折，以及截骨后的固定为什么是为什么是“双柱双柱”：三柱理论：三柱理论尺侧柱中间柱和桡侧柱尺骨远端背侧掌侧单行螺钉掌侧多行螺钉ABC3柱理论柱理论成角锁定万向锁定为什么是为什么是“万向万向”：万向锁定的原理：万向锁定的原理n偏离中偏离中轴轴15内任意方向植入螺内任意方向植入螺钉钉n四柱四柱螺螺纹纹+球形螺球形螺钉头钉头30+=VA-LCP VS.LCP
3、LCP VA-LCP1515万向万向 VS.标准锁定螺钉标准锁定螺钉锥形螺钉头锥形螺钉头圆形螺钉头圆形螺钉头标准锁定螺钉标准锁定螺钉万向锁定螺钉万向锁定螺钉万向成角的优势万向成角的优势n适适应应特殊的骨折特殊的骨折类类型，抓持某些特定的骨折型，抓持某些特定的骨折块块n螺螺钉钉定位更精准，覆盖范定位更精准，覆盖范围围更大更大n两枚螺两枚螺钉钉配合，可配合，可实现实现旋旋转稳转稳定的固定定的固定内植物内植物头部头部7孔孔头部头部6孔孔头部头部6孔，窄型孔，窄型19.5 mm22.0 mm25.5 mm宽度宽度内植物内植物25.5 mm 头部头部7孔孔 头部头部6孔孔 头部头部6孔孔，窄型7.5 m
4、m47-77 mm22 mm7.5 mm45-75 mm19.5 mm7.5 mm42-72 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预设角锁定的螺钉排列万向锁定万向锁定FeaturesBenefitsVariable AngleUp to 15 off-axis screw angulation in order to address the individual fracture patterns Better support of lunate facet and
5、 DRUJProper fixation of radial styloidPossibility of new-positioning of screwRotation stable fixation of fragments(with 2 screws)Kirschner Wire holesPreliminary plate fixation with Kirschner Wires or Plate Reduction WiresOblong LCP combi-holeAllows accurate plate positioning on the boneMain Features
6、/BenefitsFeaturesBenefitsRounded edges,polished surface and countersunk screwsReduced risk of soft tissue irritationsAnatomically pre-contouredPlate sits very close to volar ridge on the ulnar side to achieve optimal support of the lunate facetTwo-Column design1Window helps to see fracture linesWind
7、ow allows bone graft insertionMain Features/Benefits1 Picture by Prof.Ladislav Nagy,Balgrist Clinic ZurichFeaturesBenefitsTrial ImplantsPlate dimension determination for sterile users Guiding Block/Quick drill sleeveAllows guided drilling and screw insertion in the pre-defined nominal angleMain Feat
8、ures/BenefitsFeaturesBenefitsRounded corners on radial and ulnar edges to fit into smaller areaFor treatment of small-statured patientsAllows a more minimally invasive approach of patients with simple fracturesAdapted anatomical shapeEspecially designed for smaller radiiDistal angulation lowered fro
9、m 25 20 for fit on small radiiPlate sits very close to volar ridge on the ulnar side to achieve optimal support of the lunate facetMain Features/Benefits:NarrowFeatures and Benefits:VA-Buttress PinFeaturesBenefitsVA Locking Head with T8 Stardrive RecessUp to 15 off-axis screw angulation in any VA Lo
10、cking Hole2.4mm neck threadsBacks pin out for easy removalSmooth 1.8mm shaftEasy and quick insertionProvides buttressing for complex comminuted fracturesRounded TipReduces the risk of tendon irritationsVA-Buttress Pin 1.8 mm工具配置工具配置:术中选择万向或固定角锁定术中选择万向或固定角锁定015特点优势导向模块导向模块n节省时间节省时间n便于植入成角锁定螺钉便于植入成角锁定
11、螺钉便捷套筒便捷套筒n前端没有螺纹，便于插入前端没有螺纹，便于插入n钻孔，测深一步完成钻孔，测深一步完成测深器测深器n易于抓持，测量易于抓持，测量n便于清洁便于清洁产品特点产品特点万向锁定孔万向锁定孔 LCP 结合孔结合孔万向锁定螺钉万向锁定螺钉 2.4mm标准锁定螺钉标准锁定螺钉 2.4mm皮质螺钉皮质螺钉 2.4mm皮质螺钉皮质螺钉 2.7mm螺钉螺钉*只成只成 0*支撑度支撑度：VA LCP VS.LCP支撑度：支撑度：VA LCP VS.LCP增加了抗弯曲力增加了抗弯曲力双柱的稳定性是双柱的稳定性是juxtaart.接接骨板的两倍！骨板的两倍！FixedForce支撑度比较支撑度比较P
12、re-opPost-opNote:crossing screwsNote:scaphoid fracture and HCS 2.4X-Ray Examples24 year old male with AO 23C2.1 fracturePost-opPre-opNote built-in feature:Using pre-defined angles screws appear in one row in 20 inclined lateral view20Fall77 year old female with AO 23C1 fractureX-Ray ExamplesPre-opPo
13、st-opNote:crossing screws forming a basket to support the articular surface82 year old female with AO 23C2 fractureX-Ray ExamplesPre-opPost-opNote: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 fractureX-Ray ExamplesPre
14、opPost-opNote:use of K wires for preliminary fixationNote:screws have intentionally been chosen to be far below opposite cortex53 year old small statued female with AO 23 A3 fractureX-Ray Examplesn掌侧入路掌侧入路手术操作要点手术操作要点n复位骨折块复位骨折块n放置接骨板放置接骨板n在在LCP加长孔植入皮质螺钉加长孔植入皮质螺钉2.4 mm或2.7 mm手术操作要点手术操作要点n可使用可使用1.25
15、 mm克氏针克氏针n螺钉和克氏针植入的顺螺钉和克氏针植入的顺序由骨折类型决定序由骨折类型决定手术操作要点手术操作要点n钻万向锁定螺钉孔钻万向锁定螺钉孔万向LCP导钻嵌入嵌入万向锁定螺钉孔内确认嵌入后钻孔30手术操作要点手术操作要点n固定成角导钻固定成角导钻n可以解决可以解决80%的骨折类型的骨折类型 Note:带螺纹的带螺纹的LCP导钻不适用导钻不适用固定成角螺钉：方法一固定成角螺钉：方法一手术操作要点手术操作要点n导向模块结合快速导钻导向模块结合快速导钻固定成角螺钉：方法二固定成角螺钉：方法二手术操作要点手术操作要点n在远端植入万向锁定螺钉在远端植入万向锁定螺钉 确认螺钉到达理想位置后，再进
16、行最后的锁紧步骤手术操作要点手术操作要点n0.8Nm扭力限制扳手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n螺钉锁定螺钉锁定手术操作要点手术操作要点n使用使用C-arm最后鉴别最后鉴别螺钉位置螺钉位置n关闭切口关闭切口重要信息：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枚螺钉螺钉投射成一线手术操作要点手术操作要点n螺钉在没有锁定的情况下，螺钉在没有锁定的情况下，如果角度不理想，可最如果角度不理想，可最多从万向螺钉孔里取出多从万向螺钉孔里取出3次；次；n完成锁定后，该万向锁定螺钉和万
17、向螺钉孔都不能完成锁定后，该万向锁定螺钉和万向螺钉孔都不能再次使用再次使用重要提示重要提示n接骨板已预塑形接骨板已预塑形n如有必要，可适当折弯（如如有必要，可适当折弯（如图）图）n如果计划使用导向模块，则如果计划使用导向模块，则应避免折弯应避免折弯手术操作要点手术操作要点临床病例临床病例术后前后位术前前后位 术前侧位77岁女性，AO 23C1骨折，跌倒Fall术后：侧位，20倾斜20本病例治疗中未使用万向成角螺钉，可见预设的螺钉方向处于同一平面，与冠状面成20度角总结总结特点好处对医生的益处锁定孔四柱螺纹设计；球形螺钉头设计15度内万向锁定可调整螺钉角度，抓持特定骨折块双柱设计增加了支撑度增加稳定性克氏针孔可以植入克氏针临时固定接骨板解剖型设计，圆钝型边缘接骨板贴服更佳减少对肌腱的激惹节省手术时间多样的设计尺寸更多的选择范围方便医生为病人选择最合适的接骨板Thank You for Your Attention!
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