半月板缝合系统 PPT课件
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• Repeat with additional implants 相同方法植入
• Probe to assure tear is stable探钩确 认固定牢靠
30
Rapidloc™
Why is it Better?
31
Why Is It Better?
• Flexibility
- More choices for the surgeon
Required - Other pushers do not work.
19
New Pusher - Cutter
• Arthroscopic Pusher- Cutter for RapidLoc • Works as a Knot-Pusher • Cuts suture after tophat is compressed to tissue
• Preparation of the tear is critical
➢ Freshen the tear with a rasp or shaver. 修整创伤面
23
Rapidloc™
Surgical Technique
• Insert the applier through a standard portal
25
Rapidloc™
Surgical Technique
• Pass the needle through the Meniscal substance and into the Pericapsular tissue Posteriorly. 将针穿过半月板 穿到关节囊后
26
Rapidloc™
• No measuring/no fixed length
- One implant
• Dependable compression
- Controlled by surgeon
32
Why Is It Better?
• Flexible fixation柔性固定
- Suture across tear versus rigid material, like the meniscus
Anterior 1/3 Middle 1/3 Posterior 1/3
8
Meniscal Tears
TRAUMATIC 创伤性
-Younger patients -Usually sports related -More peripheral thus repairable外围可以修补 -May be associated with ACL
通过标准入路插入填充琦 ➢ Through portal alone ➢ Through a cannula ➢ With the aid of the
malleable graft retractor
24
Rapidloc™
Surgical Technique
• Use needle and silicone tubing to reduce the tear
Surgical Technique
• Pull on the limb of suture to assure capture and fixation of the backstop推 线确保固定牢靠
28
Rapidloc™
Surgical Technique
• Using the Arthroscopic pusher slide the knot and Tophat down to the surface of the tissue 用推结器将结推到半月板
Types of Tears
• Bucket handle/ vertical longitudinal
• Flap, parrot beak/ oblique • Radial/transverse
13
Types of Tears
• Cleavage/horizontal • Degenerative/complex
Surgical Technique
• Deploy the backstop 展开挡板
• Maintain pressure on the gun to prevent kickback保 持压力
• Remove needle and applier from joint 撤出针及枪
27
Rapidloc™
裂 ➢ Tears of the inner edge of meniscus半月板内缘撕裂 ➢ Preserve stable meniscus to preserve joint function
11
Treatment - Repair
• Factors to consider因素
➢ Patient age年龄 ➢ Chronicity of injury是否慢性损伤 ➢ Type, location and length of tear类型、位
3
Meniscal Anatomy
Crescent-shaped fibrocartilage 新月形纤维软骨组织 Collagen fibers arranged 胶原纤维分布 longitudinally and radially 纵形放射状分布 Triangular in cross section 横切面呈三角型
DEGENERATIVE 变性性
-Older patients -Complex tears -Usually not repairable -Age group typically not suited for repair
9
10
Treatment
• Partial Menisectomy
➢ Complex degenerative tears 复杂变性撕裂。 ➢ Central or radial tears放射状撕裂 ➢ Deformed or irreparable bucket-handle tears严重桶状
20
Rapidloc™
Meniscal Repair System
Delivery System
•Existing Meniscal Applier •Less Kickback
21
Surgical Technique
22
Rapidloc™
Surgical Technique
• Indicated for bucket-handle lesions in the Vascularized areas of the meniscus. 桶状裂
➢ Use a pull/push action ➢ Pull on the suture with
slightly more tension to avoid slack in the suture
29
Rapidloc™
Surgical Technique
• Cut the limb of suture 剪线
Lateral
Medial
5
Anatomy
6
Meniscal Blood Supply
Three Zones Red-Red Zone Red-White Zone White-White Zone
7
Classification of Tears
Location in relationship to circumference
• Minimize Articular cartilage damage关节软骨损伤最小化
- TOPHAT pivots and lies flush against tissue
33
14
What Is It?
15
Rapidloc™
Meniscal Repair System
Rapidloc™ Implant
Tophat (PLA/PDS)
Backstop (PLA)
Panacryl/ Ethibond Suture
16
RapidLoc PDS
•PDS Tophat
-Maintains 80% strength at 6 weeks -10% at 12 weeks
置、长度 ➢ Associated ligamentous injuries联合损伤
• Ideal candidate理想条件
➢ Young person年轻 ➢ Acute longitudinal peripheral tear急性纵相
外周损伤 ➢ 1-2cm in length1-2cm长
12
Βιβλιοθήκη Baidu17
Rapidloc™
Meniscal Repair System
• 27° curved needle 228322
• 12° curved needle 228321
• Straight needle 228320
18
Rapidloc™
Meniscal Repair System Arthroscopic Pusher
Mitek 半月板修复系统
1
Agenda
• Anatomy • Product overview • Instructions for use • Hands-on workshop
2
Anatomy
• Meniscal function
➢ Load transmission负荷转移 ➢ Joint stability 稳定关节 ➢ Shock absorption 振荡吸收 ➢ Joint lubrication 润滑关节 ➢ Joint nutrition 营养关节
4
Meniscal Anatomy
Lateral - circular shaped
Medial - C-shaped
Connected anteriorly by transverse meniscal ligament 在前部由半月板横韧带连接 Direct bony attachments at anterior and posterior horns 前后角骨性连接 Lateral and medial coronary ligaments 内外侧有冠状韧带
• Probe to assure tear is stable探钩确 认固定牢靠
30
Rapidloc™
Why is it Better?
31
Why Is It Better?
• Flexibility
- More choices for the surgeon
Required - Other pushers do not work.
19
New Pusher - Cutter
• Arthroscopic Pusher- Cutter for RapidLoc • Works as a Knot-Pusher • Cuts suture after tophat is compressed to tissue
• Preparation of the tear is critical
➢ Freshen the tear with a rasp or shaver. 修整创伤面
23
Rapidloc™
Surgical Technique
• Insert the applier through a standard portal
25
Rapidloc™
Surgical Technique
• Pass the needle through the Meniscal substance and into the Pericapsular tissue Posteriorly. 将针穿过半月板 穿到关节囊后
26
Rapidloc™
• No measuring/no fixed length
- One implant
• Dependable compression
- Controlled by surgeon
32
Why Is It Better?
• Flexible fixation柔性固定
- Suture across tear versus rigid material, like the meniscus
Anterior 1/3 Middle 1/3 Posterior 1/3
8
Meniscal Tears
TRAUMATIC 创伤性
-Younger patients -Usually sports related -More peripheral thus repairable外围可以修补 -May be associated with ACL
通过标准入路插入填充琦 ➢ Through portal alone ➢ Through a cannula ➢ With the aid of the
malleable graft retractor
24
Rapidloc™
Surgical Technique
• Use needle and silicone tubing to reduce the tear
Surgical Technique
• Pull on the limb of suture to assure capture and fixation of the backstop推 线确保固定牢靠
28
Rapidloc™
Surgical Technique
• Using the Arthroscopic pusher slide the knot and Tophat down to the surface of the tissue 用推结器将结推到半月板
Types of Tears
• Bucket handle/ vertical longitudinal
• Flap, parrot beak/ oblique • Radial/transverse
13
Types of Tears
• Cleavage/horizontal • Degenerative/complex
Surgical Technique
• Deploy the backstop 展开挡板
• Maintain pressure on the gun to prevent kickback保 持压力
• Remove needle and applier from joint 撤出针及枪
27
Rapidloc™
裂 ➢ Tears of the inner edge of meniscus半月板内缘撕裂 ➢ Preserve stable meniscus to preserve joint function
11
Treatment - Repair
• Factors to consider因素
➢ Patient age年龄 ➢ Chronicity of injury是否慢性损伤 ➢ Type, location and length of tear类型、位
3
Meniscal Anatomy
Crescent-shaped fibrocartilage 新月形纤维软骨组织 Collagen fibers arranged 胶原纤维分布 longitudinally and radially 纵形放射状分布 Triangular in cross section 横切面呈三角型
DEGENERATIVE 变性性
-Older patients -Complex tears -Usually not repairable -Age group typically not suited for repair
9
10
Treatment
• Partial Menisectomy
➢ Complex degenerative tears 复杂变性撕裂。 ➢ Central or radial tears放射状撕裂 ➢ Deformed or irreparable bucket-handle tears严重桶状
20
Rapidloc™
Meniscal Repair System
Delivery System
•Existing Meniscal Applier •Less Kickback
21
Surgical Technique
22
Rapidloc™
Surgical Technique
• Indicated for bucket-handle lesions in the Vascularized areas of the meniscus. 桶状裂
➢ Use a pull/push action ➢ Pull on the suture with
slightly more tension to avoid slack in the suture
29
Rapidloc™
Surgical Technique
• Cut the limb of suture 剪线
Lateral
Medial
5
Anatomy
6
Meniscal Blood Supply
Three Zones Red-Red Zone Red-White Zone White-White Zone
7
Classification of Tears
Location in relationship to circumference
• Minimize Articular cartilage damage关节软骨损伤最小化
- TOPHAT pivots and lies flush against tissue
33
14
What Is It?
15
Rapidloc™
Meniscal Repair System
Rapidloc™ Implant
Tophat (PLA/PDS)
Backstop (PLA)
Panacryl/ Ethibond Suture
16
RapidLoc PDS
•PDS Tophat
-Maintains 80% strength at 6 weeks -10% at 12 weeks
置、长度 ➢ Associated ligamentous injuries联合损伤
• Ideal candidate理想条件
➢ Young person年轻 ➢ Acute longitudinal peripheral tear急性纵相
外周损伤 ➢ 1-2cm in length1-2cm长
12
Βιβλιοθήκη Baidu17
Rapidloc™
Meniscal Repair System
• 27° curved needle 228322
• 12° curved needle 228321
• Straight needle 228320
18
Rapidloc™
Meniscal Repair System Arthroscopic Pusher
Mitek 半月板修复系统
1
Agenda
• Anatomy • Product overview • Instructions for use • Hands-on workshop
2
Anatomy
• Meniscal function
➢ Load transmission负荷转移 ➢ Joint stability 稳定关节 ➢ Shock absorption 振荡吸收 ➢ Joint lubrication 润滑关节 ➢ Joint nutrition 营养关节
4
Meniscal Anatomy
Lateral - circular shaped
Medial - C-shaped
Connected anteriorly by transverse meniscal ligament 在前部由半月板横韧带连接 Direct bony attachments at anterior and posterior horns 前后角骨性连接 Lateral and medial coronary ligaments 内外侧有冠状韧带