后外側(cè)脛骨平臺骨折PPT課件

1、.,1,后外側(cè)脛骨平臺骨折,潘德悅,.,2,定義,脛骨平臺骨折-是指骨折線累及脛骨近端關(guān)節(jié)面的骨折 后外側(cè)脛骨平臺的定義？,.,3,后外側(cè),.,4,后外側(cè)脛骨平臺,.,5,解剖,.,6,解剖,.,7,解剖,A：46.39.0mm B：35.79.0mm,后側(cè)血管,脛前動脈ATA,腘動脈,不能結(jié)扎！,.,8,解剖,后外側(cè)復(fù)合體！ （PLC）,維持膝關(guān)節(jié)后外側(cè)穩(wěn)定 外側(cè)副韌帶 腘肌腱復(fù)合體 腘腓韌帶 弓狀韌帶 后外側(cè)關(guān)節(jié)囊,.,9,解剖,外翻角：87 （85-90） 后傾角：0-10,Cong-Feng Luo.Reference axes for reconstruction of the kn

2、ee. The Knee 2004, 11:253-257,.,10,損傷機(jī)制,低能量損傷,屈曲,伸直,外翻,內(nèi)翻,過伸,.,11,影像學(xué)檢查,X線 CT MRI CTA或動脈血管造影,.,12,分型,Schatzker 分型 AO/OTA分型 三柱分型 Hohl-Moore分型,.,13,Schatzker 分型,Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res. 1979 Jan-Feb;(138):94-

3、104.,.,14,AO/OTA分型,關(guān)節(jié)外骨折(Type A) 單髁骨折(Type B) 雙髁骨折(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,這是幾型？,AO ： 41-B3 Schatzker：型 三柱：外側(cè)+后側(cè)柱,.,17,治療,.,18,關(guān)節(jié)塌陷和分離3 mm 干骺端明顯移位或成角5 開放性骨折合并血管神經(jīng)損傷 出現(xiàn)

4、骨筋膜間隔綜合征等 屈膝不穩(wěn)單純后外側(cè)平臺骨折,治療,手術(shù)治療指征,1.Thomas C，Athanasiov A，Wullschleger M，et a1Current concepts in tibial plateau fracturesJActa Chir Orthop Traumatol Cech，2009，76(5)：363373 2.Papagelopoulos PJ,Partsinevelos AA,Themistocleous GS,et al.Complications after tibia plateau fracture surgeryJ.Injury,2006,37

5、(6)：475484,.,19,前外側(cè)入路,治療,.,20,后正中入路,Hughston JC. A surgical approach to the medial and posterior ligaments of the knee. Clin Orthop Relat Res 1973;91(91):2933,.,21,倒L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):683-9

6、2.,.,22,擴(kuò)大 Tscherne-Johnson 入路,治療,Johnson 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,后外側(cè)骨折-后外側(cè)切口入路,Chang SM, Zheng HP, Li HF, Jia YW, Huang YG, Wang X, Yu GR. Treatment of isolated po

7、sterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation. Arch Orthop Trauma Surg. 2009 Jul;129(7):955-62,.,24,Chang SM, Zheng HP, Li HF, Jia YW, Huang YG, Wang X, Yu GR. Treatment of isolated posterior coronal fracture of

8、 the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation. Arch Orthop Trauma Surg. 2009 Jul;129(7):955-62,后外側(cè)骨折-后外側(cè)切口入路,.,25,后外側(cè)骨折-前外側(cè)擴(kuò)大切口入路,.,26,后外側(cè)骨折-后正中切口入路,.,27,后外側(cè)骨折-腓骨頭截骨入路,Yu B, Han K, Zhan C, Zhang C, Ma H, Su J. Fibular head osteotomy: a ne

9、w approach for the treatment of lateral or posterolateral tibial plateau fractures.Knee. 2010 Oct;17(5):313-8.,.,28,后外側(cè)骨折-Carlson入路,Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthop Trauma.2005 Feb;19(2):73-8,.,29,Frosch KH, Balcarek P, Walde T, Strmer KM. A new posterolateral appr

10、oachwithout fibula osteotomy for the treatment of tibial plateau fractures. J Orthop Trauma. 2010 Aug;24(8):515-20.,后外側(cè)骨折-Frosch入路,.,30,經(jīng)腓骨頭上入路,.,31,后（外）側(cè)入路問題 暴露困難，易損傷血管神經(jīng) 復(fù)位困難，無法直視關(guān)節(jié)面 力線糾正不足,.,32,后（外）側(cè)入路優(yōu)點(diǎn) 直接復(fù)位 可以有效固定,.,33,常見治療方式,.,34,拉力螺釘 鎖定鋼板 普通鋼板 克氏針 空心加壓螺釘 髓內(nèi)釘,內(nèi)固定材料,治療,.,35,后外側(cè)骨折復(fù)位,經(jīng)骨折線復(fù)位 開窗 截骨

11、 后（外）側(cè)入路,.,36,經(jīng)骨折線復(fù)位,.,37,后外側(cè)骨折常見固定方式,.,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.,.,39,.,40,內(nèi)固定技術(shù),Raft技術(shù) （竹筏或排釘技術(shù)）,Cross WW 3rd, Levy BA, Morgan JA, Armi

12、tage BM, Cole PA. Periarticular raft constructs and fracture stability in split-depression tibial plateau fractures.Injury. 2013 Jun;44(6):796-801.,.,41,JAIL（網(wǎng)格）技術(shù),Weimann A, Heinkele T, Herbort M, Schliemann B, Petersen W, Raschke MJ. Minimally invasive reconstruction of lateral tibial plateau frac

13、tures using the jail technique: a biomechanical study. BMC Musculoskelet Disord. 2013 Apr 4;14:120.,內(nèi)固定技術(shù),.,42,經(jīng)皮內(nèi)固定技術(shù),This new technique is recommended for fractures with cleavage and compression or only compression,.,43,球囊復(fù)位技術(shù),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