医学ppt球囊成形治疗胫骨平台骨折

2015年6月 Balloon Tibioplasty: A Useful Tool for Reduction of Tibial Plateau Depression Fractures 球囊成形术治疗胫骨平台塌陷性骨折 导师：查振刚 教授 学生：顾容赫 2 Schatzker type Schatzker type 3 The common fracture patterns encountered are split depression (OTA Type B3, Schatzker Type II) and lateral depression (OTA type B2,Schatzker type III).They prevailing in elderly patients due to osteopenia or osteoporosis。 Schatzker IISchatzker III 胫骨平台常见的Schatzker type II/III 骨折多见于骨质减少或骨质疏松的老年人 。 BackgroundsBackgrounds Numerous techniques have been described to treat depressed tibial plateau fractures. With all techniques, the depression needs to be elevated mechanically with the use of metallic instruments through bone windows. 传统方法：切开在关节面塌陷下方开窗 +金属棒撬拨+植骨填充+钢板内固定 Backgrounds Backgrounds Backgrounds Backgrounds shortage ： Depending on the instrument used and the bone quality, elevating a depressed fragment may make the defect worse or lead to intra -articular penetration. 不足 : 1）直接撬拨顶推创伤大。 2） 因骨质疏松，撬拨容易加重骨折。 3）植骨填充时，容易导致复位关节面 重 新塌陷或矫枉过正。 Backgrounds Backgrounds As we know , percutaneous vertebroplasty（PVP ）with inflatable has been use in Compression vertebral fractures in Aged . 我们知道：经皮椎体成形术已经广泛的用 于治疗老年人压缩性椎体骨折。 MethodMethod To minimize the diameter of the tibial bone window and to simultaneously increase the area of power transmission to elevate the depressed plateau, Pizanis used an inflatable kyphoplasty balloon as a reduction aid。 为了减少胫骨的创伤及尽可能复位好塌陷的 胫骨平台，德国的一位研究者使用球囊扩张骨 水泥成形来复位胫骨塌陷性骨折。 MethodMethod A fragment locking T-plate balloon K-wires cortical screw 胫骨外侧锁定T形钢板 球囊 克氏针 皮质骨螺钉 MethodMethod Intraoperative fluoroscopic monitoring (side view) of the reduction process by balloon tibioplasty. Note the gradual elevation of the depressed articular area (arrows). 术中C臂透视侧位片，显示球囊 成形过程。注意观察塌陷平台的 抬高过程（箭头） A、 75year-old man with displaced split depression type fracture in CT of the tibial plateau (Schatzker type II). 75岁，男，胫骨平台骨折， Schatzker II B、 Tibial plateau fractures Arthroscopic. 关节镜下胫骨平台Schatzker II 骨折表现 PatientsPatients PatientsPatients A、 A visual check under the lateral meniscus or an arthroscopic assessment of anatomic joint reduction completes the reduction procedure 扩张球囊上抬塌陷的平台时，同时直视或关节镜下观察胫骨平台复 位情况。 B、 X-ray after operation. 术后X线表现。 PatientsPatients A、 Seventy-year-old woman with a displaced lateral tibial plateau fracture (Schatzker III, OTA B2.2). B、After full weight bearing without correction loss and barely noticeable scar after minimal invasive approach. C、follow-up (21 months)and CT excluding osteolysis aroundthe bone substitute, clinically optimalresult with return to previous sports activities MethodMethod J Bone Joint Surg Am. 2014 Aug 6;96(15):1273-1279. Reduction and Stabilization of Depressed Articular Tibial Plateau Fractures: Comparison of Inflatable and Conventional Bone Tamps: Study of a Cadaver Model. 尸体上C臂透视下两种手术方法 左图：球囊扩张复位塌陷胫骨平台 右图 ：传统金属棒撬拨复位法 Fluoroscopic images illustrating the reduction On the right is the lateral cortical window with conventional tamp and on the left is the inflatable tamp. The reduction quality The reduction quality Number of pairs in which the reduction quality of the side treated with the inflatable bone tamp (IBT) was rated as better than, equivalent to, or worse than that on the contralateral control side reduced with the conventional bone tamps (CBT), as determined with the three evaluation methods. 图中IBT代表球囊复位， CBT代表传统撬拨复位， 经透视、CT、直观行双盲 评估， 结果：关节面复位效果 球囊扩张组优于 传统撬拨复位组 The reduction qualityThe reduction quality Photographs of the fractured lateral tibial plateau surfaces before (Fig. 1-A) and after (Fig. 1 -B) reduction with an inflatable tamp and before (Fig. 1-C) and after (Fig. 1-D) reduction with the conventional tamp on the contralateral side. 图A/C：胫骨平台压缩性骨折尸 体模型 图B:球囊扩张复位后表面，平滑 图D:金属棒撬拨复位后表面，粗糙 软骨破损 J Bone Joint Surg Am. 2014 Aug 6;96(15):1273-1279. The reduction qualityThe reduction quality Median residual defect volume expressed as a percentage of the depressed defect volume for fourteen specimens treated with an inflatable bone tamp (IBT)and fourteen contralateral specimens treated with conventional bone tamps (CBT). The dispersion bars represent the inter quartile range. 图中红柱代表球囊复位组 ， 黑柱代表传统撬拨复位组 ， 结果：总体复位不良率 球囊扩张组小于 传统撬拨复位组 The stiffness and yield loadThe stiffness and yield load Median stiffness and yield load during static loading of fourteen specimens treated with an inflatable bone tamp (IBT) and fourteen contralateral specimens treated with conventional bone tamps (CBT). The dispersion bars repr- esent the interquartile range. . 图中I黑柱代表球囊复位， 红柱代表传统撬拨复位， 结果：静态负荷强度中 刚度和屈服载荷 球囊扩张组均强于 传统撬拨复位组 Conclusi