后外侧胫骨平台骨折课件.pptx

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1、后外侧胫骨平台骨折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？后外侧 后外侧胫骨平台解剖解剖解剖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！不能结扎！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解剖外翻角：外翻角：87 （85-90）后倾角：后倾角：0-10Cong-Feng Luo.Reference axes for reconstruction

2、 of the knee.The Knee 2004,11:253-257损伤机制屈曲伸直外翻内翻过伸影像学检查n nX线n nCTn nMRIn nCTA或动脉血管造影分型Schatzker 分型AO/OTA分型三柱分型Hohl-Moore分型Schatzker 分型Schatzker J,McBroom R,Bruce D.The tibial plateau fracture.The Torontoexperience 1968-1975.Clin Orthop Relat Res.1979 Jan-Feb;(138):94-104.AO/OTA分型关节外骨折(Type A)单髁骨折(T

3、ype B)双髁骨折(TyPe C)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.这是几型？AO：41-B3 Schatzker：型 三柱：外侧+后侧柱 治疗n n关节塌陷和分离3 mmn n干骺端明显移位或成角5n n开放性骨折合并血管神经损伤n n出现骨筋膜间隔综合征等n n屈膝不稳单纯后外侧平台骨折治疗手术治疗指征1.Thomas C，Athanasiov A，Wullsch

4、leger 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)：475484前外侧入路前外侧入路治疗后正中入路后正中入路Hughston JC.A surgical approach to

5、 the medial and posterior ligaments of the knee.Clin Orthop Relat Res 1973;91(91):2933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.扩大扩大 Tscherne-Johnson 入路入路治疗Johnson EE,Timon S,Osuji C.Surgical technique:Tscher

6、ne-Johnson extensile approach for tibial plateau fractures.Clin Orthop Relat Res.2013 Sep;471(9):2760-7.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 lateral tibial plateau throughposterolateral approach for direc

7、t exposure and buttress plate fixation.ArchOrthop Trauma Surg.2009 Jul;129(7):955-62Chang SM,Zheng HP,Li HF,Jia YW,Huang YG,Wang X,Yu GR.Treatment ofisolated posterior coronal fracture of the lateral tibial plateau throughposterolateral approach for direct exposure and buttress plate fixation.ArchOr

8、thop 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后外侧骨折后外侧骨折-后正中切口入路后正中切口入路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 approach for the treatment of lateral or posterolateral tibial plateau fractures.Knee.2010

9、Oct;17(5):313-8.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):73-8Frosch KH,Balcarek P,Walde T,StFrosch KH,Balcarek P,Walde T,St rmer KM.A new posterolateral rmer KM.A new posterolateral approachwithout fibula osteotomy for the treatmen

10、t of tibial approachwithout fibula osteotomy for the treatment of tibial plateau fractures.J Orthop Trauma.2010 Aug;24(8):515-20.plateau fractures.J Orthop Trauma.2010 Aug;24(8):515-20.后外侧骨折后外侧骨折-Frosch入路入路经腓骨头上入路经腓骨头上入路后（外）侧入路问题n n暴露困难，易损伤血管神经暴露困难，易损伤血管神经n n复位困难，无法直视关节面复位困难，无法直视关节面n n力线纠正不足力线纠正不足后（

11、外）侧入路优点n直接复位n可以有效固定常见治疗方式n n拉力螺钉拉力螺钉n n锁定钢板锁定钢板n n普通钢板普通钢板n n克氏针克氏针n n空心加压螺钉空心加压螺钉n n髓内钉髓内钉内固定材料治疗 后外侧骨折复位后外侧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）侧入路经骨折线复位 后外侧骨折常见固定方式 Zhang W,Luo CF,Putnis S,Sun H,Zeng ZM,Zeng BF.Biomechanical analysis of four different fixations for the posterolateral shearing tibia

12、l plateau fracture.Knee.2012 Mar;19(2):94-8.内固定技术Raft技术（竹筏或排钉技术）Cross WW 3rd,Levy BA,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.JAIL（网格）技术 Weimann A,Heinkele T,Herbort M,Schliemann B,Pe

13、tersen W,Raschke MJ.Minimally invasive reconstruction of lateral tibial plateau fractures using thejail technique:a biomechanical study.BMC Musculoskelet Disord.2013 Apr4;14:120.内固定技术经皮内固定技术This new technique is recommended for fractures with cleavage and compression or only compression球囊复位技术Heiney

14、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):1273-1279病例分享患者，男，患者，男，49岁，岁，“摔伤致右摔伤致右膝关节疼痛、活动受限膝关节疼痛、活动受限5小时小时”入院。入院。查体：右膝肿胀，无皮肤破溃，查体：右膝肿胀，无皮肤破溃，可见瘀斑，皮肤张力可，右膝可见瘀斑，皮肤张力可，右膝外侧压痛明显外侧压痛明显，右下肢触痛觉，右下肢触痛觉正常正常，右膝屈伸活动因痛受限，右膝屈伸活动因痛受限，右足背动脉搏动良好。右足背动脉搏动良好。术前术前CTCT内侧切口内侧切口外侧切口外侧切口手术切口手术切口术后复查术后复查术后复查术后复查谢谢！