后外侧胫骨平台骨折ppt课件

后外侧胫骨平台骨折,潘德悦,1,定义,胫骨平台骨折-是指骨折线累及胫骨近端关节面的骨折后外侧胫骨平台的定义？,2,后外侧,3,后外侧胫骨平台,4,解剖,5,解剖,6,解剖,A：46.39.0mmB：35.79.0mm,后侧血管,胫前动脉ATA,腘动脉,不能结扎！,7,解剖,后外侧复合体！（PLC）,维持膝关节后外侧稳定外侧副韧带腘肌腱复合体腘腓韧带弓状韧带后外侧关节囊,8,解剖,外翻角：87（85-90）后倾角：0-10,Cong-FengLuo.Referenceaxesforreconstructionoftheknee.TheKnee2004,11:253-257,9,损伤机制,低能量损伤,屈曲,伸直,外翻,内翻,过伸,10,影像学检查,X线CTMRICTA或动脉血管造影,11,分型,Schatzker分型AO/OTA分型三柱分型Hohl-Moore分型,12,Schatzker分型,SchatzkerJ,McBroomR,BruceD.Thetibialplateaufracture.TheTorontoexperience1968-1975.ClinOrthopRelatRes.1979Jan-Feb;(138):94-104.,13,AO/OTA分型,关节外骨折(TypeA)单髁骨折(TypeB)双髁骨折(TyPeC),14,三柱分型,LuoCF,SunH,ZhangB,ZengBF.Three-columnfixationforcomplextibialplateaufractures.JOrthopTrauma.2010Nov;24(11):683-92.,15,这是几型？,AO：41-B3Schatzker：型三柱：外侧+后侧柱,16,治疗,17,关节塌陷和分离3mm干骺端明显移位或成角5开放性骨折合并血管神经损伤出现骨筋膜间隔综合征等屈膝不稳单纯后外侧平台骨折,治疗,手术治疗指征,1.ThomasC，AthanasiovA，WullschlegerM，eta1CurrentconceptsintibialplateaufracturesJActaChirOrthopTraumatolCech，2009，76(5)：3633732.PapagelopoulosPJ,PartsinevelosAA,ThemistocleousGS,etal.ComplicationsaftertibiaplateaufracturesurgeryJ.Injury,2006,37(6)：475484,18,前外侧入路,治疗,19,后正中入路,HughstonJC.Asurgicalapproachtothemedialandposteriorligamentsoftheknee.ClinOrthopRelatRes1973;91(91):2933,20,倒L入路,LuoCF,SunH,ZhangB,ZengBF.Three-columnfixationforcomplextibialplateaufractures.JOrthopTrauma.2010Nov;24(11):683-92.,21,扩大Tscherne-Johnson入路,治疗,JohnsonEE,TimonS,OsujiC.Surgicaltechnique:Tscherne-Johnsonextensileapproachfortibialplateaufractures.ClinOrthopRelatRes.2013Sep;471(9):2760-7.,22,后外侧骨折-后外侧切口入路,ChangSM,ZhengHP,LiHF,JiaYW,HuangYG,WangX,YuGR.Treatmentofisolatedposteriorcoronalfractureofthelateraltibialplateauthroughposterolateralapproachfordirectexposureandbuttressplatefixation.ArchOrthopTraumaSurg.2009Jul;129(7):955-62,23,ChangSM,ZhengHP,LiHF,JiaYW,HuangYG,WangX,YuGR.Treatmentofisolatedposteriorcoronalfractureofthelateraltibialplateauthroughposterolateralapproachfordirectexposureandbuttressplatefixation.ArchOrthopTraumaSurg.2009Jul;129(7):955-62,后外侧骨折-后外侧切口入路,24,后外侧骨折-前外侧扩大切口入路,25,后外侧骨折-后正中切口入路,26,后外侧骨折-腓骨头截骨入路,YuB,HanK,ZhanC,ZhangC,MaH,SuJ.Fibularheadosteotomy:anewapproachforthetreatmentoflateralorposterolateraltibialplateaufractures.Knee.2010Oct;17(5):313-8.,27,后外侧骨折-Carlson入路,CarlsonDA.Posteriorbicondylartibialplateaufractures.JOrthopTrauma.2005Feb;19(2):73-8,28,FroschKH,BalcarekP,WaldeT,StrmerKM.Anewposterolateralapproachwithoutfibulaosteotomyforthetreatmentoftibialplateaufractures.JOrthopTrauma.2010Aug;24(8):515-20.,后外侧骨折-Frosch入路,29,经腓骨头上入路,30,后（外）侧入路问题暴露困难，易损伤血管神经复位困难，无法直视关节面力线纠正不足,31,后（外）侧入路优点直接复位可以有效固定,32,常见治疗方式,33,拉力螺钉锁定钢板普通钢板克氏针空心加压螺钉髓内钉,内固定材料,治疗,34,后外侧骨折复位,经骨折线复位开窗截骨后（外）侧入路,35,经骨折线复位,36,后外侧骨折常见固定方式,37,ZhangW,LuoCF,PutnisS,SunH,ZengZM,ZengBF.Biomechanicalanalysisoffourdifferentfixationsfortheposterolateralshearingtibialplateaufracture.Knee.2012Mar;19(2):94-8.,38,39,内固定技术,Raft技术（竹筏或排钉技术）,CrossWW3rd,LevyBA,MorganJA,ArmitageBM,ColePA.Periarticularraftconstructsandfracturestabilityinsplit-depressiontibialplateaufractures.Injury.2013Jun;44(6):796-801.,40,JAIL（网格）技术,WeimannA,HeinkeleT,HerbortM,SchliemannB,PetersenW,RaschkeMJ.Minimallyinvasivereconstructionoflateraltibialplateaufracturesusingthejailtechnique:abiomechanicalstudy.BMCMusculoskeletDisord.2013Apr4;14:120.,内固定技术,41,经皮内固定技术,Thisnewtechniqueisrecommendedforfractureswithcleavageandcompressionoronlycompression,42,球囊复位技术,HeineyJP,KursaK,SchmidtAH,StannardJP.ReductionandStabilizationofDepressedArticularTibialPlateauFractures:ComparisonofInflatableandConventionalBoneTamps:StudyofaCadaverModel.JBoneJointSurgAm.