后外侧胫骨平台骨折（课堂PPT）

1、1后外侧胫骨平台骨折后外侧胫骨平台骨折潘德悦2定义胫骨平台骨折胫骨平台骨折-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？后外侧胫骨平台的定义？3后外侧4 后外侧胫骨平台5解剖6解剖7解剖A：46.39.0mmB：35.79.0mm后侧血管后侧血管胫前动脉ATA腘动脉不能结扎！8解剖后外侧复合体！后外侧复合体！ （PLC）维持膝关节后外侧稳定维持膝关节后外侧稳定外侧副韧带外侧副韧带腘肌腱复合体腘肌腱复合体腘腓韧带腘腓韧带弓状韧带弓状韧带后外侧关节囊后外侧关节囊9解剖外翻角：外翻角：87 （85-90） 后倾角：后倾角：0-10Cong-Feng Luo.Reference axes

2、for reconstruction of the knee. The Knee 2004, 11:253-25710损伤机制低能量损伤屈曲伸直外翻内翻过伸11影像学检查 X线 CT MRI CTA或动脉血管造影12分型Schatzker 分型AO/OTA分型三柱分型Hohl-Moore分型13Schatzker 分型Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Torontoexperience 1968-1975. Clin Orthop Relat Res. 1979 Jan-Feb;(138):94-

3、104.14AO/OTA分型关节外骨折(Type A)单髁骨折(Type B)双髁骨折(TyPe C)15三柱分型Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010 Nov;24(11):683-92.16这是几型？AO ： 41-B3 Schatzker：型 三柱：外侧+后侧柱 17治疗18 关节塌陷和分离3 mm 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 屈膝不稳治疗手术治疗指征1

4、.Thomas C，Athanasiov A，Wullschleger M，et a1Current concepts in tibial plateau fracturesJActa Chir Orthop Traumatol Cech，2009，76(5)：3633732.Papagelopoulos PJ,Partsinevelos AA,Themistocleous GS,et al.Complications after tibia plateau fracture surgeryJ.Injury,2006,37(6)：47548419前外侧入路前外侧入路治疗20后正中入路后正中入路

5、Hughston JC. A surgical approach to the medial and posterior ligaments of the knee. Clin Orthop Relat Res 1973;91(91):293321倒倒L入路入路Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010 Nov;24(11):683-92.22扩大扩大 Tscherne-Johnson 入路入路治疗Johnso

6、n EE, Timon S, Osuji C. Surgical technique: Tscherne-Johnson extensile approach for tibial plateau fractures. Clin Orthop Relat Res. 2013 Sep;471(9):2760-7.23后外侧骨折后外侧骨折-后外侧切口入路后外侧切口入路Chang SM, Zheng HP, Li HF, Jia YW, Huang YG, Wang X, Yu GR. Treatment ofisolated posterior coronal fracture of the la

7、teral tibial plateau throughposterolateral approach for direct exposure and buttress plate fixation. ArchOrthop Trauma Surg. 2009 Jul;129(7):955-6224Chang SM, Zheng HP, Li HF, Jia YW, Huang YG, Wang X, Yu GR. Treatment ofisolated posterior coronal fracture of the lateral tibial plateau throughposter

8、olateral approach for direct exposure and buttress plate fixation. ArchOrthop Trauma Surg. 2009 Jul;129(7):955-62后外侧骨折后外侧骨折-后外侧切口入路后外侧切口入路25后外侧骨折后外侧骨折-前外侧扩大切口入路前外侧扩大切口入路26后外侧骨折后外侧骨折-后正中切口入路后正中切口入路27后外侧骨折后外侧骨折-腓骨头截骨入路腓骨头截骨入路 Yu B, Han K, Zhan C, Zhang C, Ma H, Su J. Fibular head osteotomy: a new appr

9、oach for the treatment of lateral or posterolateral tibial plateau fractures.Knee. 2010 Oct;17(5):313-8.28后外侧骨折后外侧骨折-Carlson入路入路Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthop Trauma.2005 Feb;19(2):73-829Frosch KH, Balcarek P, Walde T, Strmer KM. A new posterolateral approachwith

10、out fibula osteotomy for the treatment of tibial plateau fractures. J Orthop Trauma. 2010 Aug;24(8):515-20.后外侧骨折后外侧骨折-Frosch入路入路30经腓骨头上入路经腓骨头上入路31后（外）侧入路问题n 暴露困难，易损伤血管神经n 复位困难，无法直视关节面n 力线纠正不足32后（外）侧入路优点n 直接复位n 可以有效固定33常见治疗方式34 拉力螺钉拉力螺钉 锁定钢板锁定钢板 普通钢板普通钢板 克氏针克氏针 空心加压螺钉空心加压螺钉 髓内钉髓内钉内固定材料治疗35 后外侧骨折复位后外侧

11、骨折复位 经骨折线复位经骨折线复位 开窗开窗 截骨截骨 后（外）侧入路后（外）侧入路36经骨折线复位37 后外侧骨折常见固定方式38 Zhang W, Luo CF, Putnis S, Sun H, Zeng ZM, Zeng BF. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture.Knee. 2012 Mar;19(2):94-8.3940内固定技术Raft技术（竹筏或排钉技术） Cross WW 3rd, Levy BA,

12、Morgan JA, Armitage BM, Cole PA. Periarticular raft constructs and fracture stability in split-depression tibial plateau fractures.Injury. 2013 Jun;44(6):796-801.41JAIL（网格）技术 Weimann A, Heinkele T, Herbort M, Schliemann B, Petersen W, Raschke MJ.Minimally invasive reconstruction of lateral tibial pl

13、ateau fractures using thejail technique: a biomechanical study. BMC Musculoskelet Disord. 2013 Apr4;14:120.内固定技术42经皮内固定技术This new technique is recommended for fractures with cleavage and compression or only compression43球囊复位技术Heiney JP, Kursa K, Schmidt AH, Stannard JP. Reduction and Stabilization of Depressed Articular Tibial Plateau Fractures: Comparison of Inflatable and Conventional Bone Tamps: Study of a Cadaver Model. J Bone Joint Surg Am. 2014 Aug 6;96(15):1273-127944