医学--球囊成形治疗胫骨平台骨折课件.ppt
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 2Schatzker 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。Backgrounds 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：传统方法：切开在关节面塌陷下方开窗切开在关节面塌陷下方开窗+金属棒撬拨金属棒撬拨+植骨填充植骨填充+钢板内固定钢板内固定 Backgrounds Backgrounds As we know,percutaneous vertebroplasty（PVP）with inflatable has been use in Compression vertebral fractures in Aged.我们知道：我们知道：经皮椎体成形术已经广泛的用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。于治疗老年人压缩性椎体骨折。Method 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。水泥成形来复位胫骨塌陷性骨折。Method A fragment locking T-plate balloon K-wires cortical screw 胫骨外侧锁定胫骨外侧锁定T形钢板形钢板 球囊球囊 克氏针克氏针 皮质骨螺钉皮质骨螺钉 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，岁，男，胫骨平台骨折，Schatzker II B、Tibial plateau fractures Arthroscopic.关节镜下胫骨平台关节镜下胫骨平台Schatzker II 骨折表现骨折表现AB PatientsPatientsA、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。位情况。B、X-ray after operation.术后术后X线表现线表现。AMethod 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.尸体上尸体上C臂透视下臂透视下两种两种手手术方法术方法 左图：左图：球囊扩张复位塌陷胫骨平台球囊扩张复位塌陷胫骨平台 右图右图：传统金属棒撬拨复位法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 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.图图A/C：胫骨平台压缩性骨折尸 体模型 图图B:球囊扩张复位后表面，平滑 图图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 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.图中图中红柱红柱代表球囊复位代表球囊复位组组，黑柱黑柱代表传统撬拨复位代表传统撬拨复位组组，结果结果：总体复位不良率总体复位不良率 球囊扩张组球囊扩张组小小于于 传统撬拨复位组传统撬拨复位组 Conclusions inflatable bone tamp had better reduction：1、smoother articular surface with less residual defect volume 2、exhibited less subsidence during cyclic loading and greater stiffness under static loading 谢谢谢谢！Thanks for your attention
