球囊成形治療脛骨平臺(tái)骨折

1、2015年6月Balloon Tibioplasty: A Useful Tool for Reduction of Tibial Plateau Depression Fractures 球囊成形術(shù)治療脛骨平臺(tái)塌陷性骨折 導(dǎo)師：查振剛 教授學(xué)生：顧容赫 23 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

2、 elderly patients due to osteopenia or osteoporosis。 Schatzker IISchatzker III 脛骨平臺(tái)常見的Schatzker type II/III骨折多見于骨質(zhì)減少或骨質(zhì)疏松的老年人。 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 me

3、tallic instruments through bone windows. 傳統(tǒng)方法：傳統(tǒng)方法：切開在關(guān)節(jié)面塌陷下方開窗切開在關(guān)節(jié)面塌陷下方開窗+金屬棒撬撥金屬棒撬撥+植骨填充植骨填充+鋼板內(nèi)固定鋼板內(nèi)固定 shortage shortage ： Depending on the instrument used and the bone quality, elevating a depressed fragment may make the defect worse or lead to intra-articular penetration. 不足不足 : 1）直接撬撥頂推創(chuàng)傷大。）直

4、接撬撥頂推創(chuàng)傷大。 2） 因骨質(zhì)疏松，撬撥容易加重骨折。因骨質(zhì)疏松，撬撥容易加重骨折。 3）植骨填充時(shí)，容易導(dǎo)致復(fù)位關(guān)節(jié)面）植骨填充時(shí)，容易導(dǎo)致復(fù)位關(guān)節(jié)面 重重 新塌陷或矯枉過正。新塌陷或矯枉過正。 As we know , percutaneous vertebroplasty（PVP ）with inflatable has been use in Compression vertebral fractures in Aged . 我們知道：我們知道：經(jīng)皮椎體成形術(shù)已經(jīng)廣泛的用經(jīng)皮椎體成形術(shù)已經(jīng)廣泛的用于治療老年人壓縮性椎體骨折。于治療老年人壓縮性椎體骨折。 To minimize the

5、 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。 為了減少脛骨的創(chuàng)傷及盡可能復(fù)位好塌陷的為了減少脛骨的創(chuàng)傷及盡可能復(fù)位好塌陷的脛骨平臺(tái)，德國的一位研究者使用球囊擴(kuò)張骨脛骨平臺(tái)，德國的一位研究者使用球囊擴(kuò)張骨水泥成形來復(fù)位脛骨塌陷性骨折。水泥成形來復(fù)位脛

6、骨塌陷性骨折。 A fragment locking T-plate balloon K-wires cortical screw 脛骨外側(cè)鎖定脛骨外側(cè)鎖定T形鋼板形鋼板 球囊球囊 克氏針克氏針 皮質(zhì)骨螺釘皮質(zhì)骨螺釘 Intraoperative fluoroscopic monitoring (side view) of the reduction process by balloon tibioplasty. Note the gradualelevation of the depressed articular area (arrows). 術(shù)中術(shù)中C臂透視臂透視側(cè)位片，顯示球囊側(cè)位片，

7、顯示球囊成形過程。注意觀察塌陷平臺(tái)的成形過程。注意觀察塌陷平臺(tái)的抬高過程（箭頭抬高過程（箭頭）A、 75year-old man with displaced split depression type fracture in CT of the tibial plateau (Schatzker type II). 75歲，男，脛骨平臺(tái)骨折，歲，男，脛骨平臺(tái)骨折， Schatzker II B、 Tibial plateau fractures Arthroscopic. 關(guān)節(jié)鏡下脛骨平臺(tái)關(guān)節(jié)鏡下脛骨平臺(tái)Schatzker II 骨折表現(xiàn)骨折表現(xiàn) A、 A visual check unde

8、r the lateral meniscus or an arthroscopic assessment of anatomic joint reduction completes the reduction procedure擴(kuò)張球囊上抬塌陷的平臺(tái)時(shí)，同時(shí)直視或關(guān)節(jié)鏡下觀察脛骨平臺(tái)復(fù)擴(kuò)張球囊上抬塌陷的平臺(tái)時(shí)，同時(shí)直視或關(guān)節(jié)鏡下觀察脛骨平臺(tái)復(fù)位情況。位情況。B、 X-ray after operation. 術(shù)后術(shù)后X線表現(xiàn)線表現(xiàn)。A、 Seventy-year-old woman with a displaced lateral tibial plateau fracture (Schatz

9、ker III, OTA B2.2). B、After full weight bearing without correction loss and barely noticeable scar after minimal invasive approach. C、follow-up (21 months)and CT excluding osteolysis aroundthe bone substitute, clinically optimalresult with return to previous sports activities J Bone Joint Surg Am. 2

10、014 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. 尸體上尸體上C臂透視下臂透視下兩種兩種手手術(shù)方法術(shù)方法 左圖：左圖：球囊擴(kuò)張復(fù)位塌陷脛骨平臺(tái)球囊擴(kuò)張復(fù)位塌陷脛骨平臺(tái) 右圖右圖 ：傳統(tǒng)金屬棒撬撥復(fù)位法傳統(tǒng)金屬棒撬撥復(fù)位法 Fluoroscopic images illustrat

11、ing the reduction On the right is the lateral cortical window with conventional tamp and on the left is the inflatable tamp. Number of pairs in which the reduction quality of the side treated with the inflatable bone tamp (IBT) was rated as better than, equivalent to, or worse than that on the contr

12、alateral control side reduced with the conventional bone tamps (CBT), as determined with the three evaluation methods.圖中圖中IBT代表球囊復(fù)位，代表球囊復(fù)位，CBT代表傳統(tǒng)撬撥復(fù)位，代表傳統(tǒng)撬撥復(fù)位，經(jīng)透視、經(jīng)透視、CT、直觀行雙盲、直觀行雙盲評(píng)估，評(píng)估，結(jié)果結(jié)果：關(guān)節(jié)面復(fù)位效關(guān)節(jié)面復(fù)位效果果 球囊擴(kuò)張組球囊擴(kuò)張組優(yōu)優(yōu)于于 傳統(tǒng)撬撥復(fù)位組傳統(tǒng)撬撥復(fù)位組 Photographs of the fractured lateral tibial plateau surfaces b

13、efore (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. 圖圖A/C：脛骨平臺(tái)壓縮性骨折尸 體模型 圖圖B:球囊擴(kuò)張復(fù)位后表面，平滑 圖圖D:金屬棒撬撥復(fù)位后表面，粗糙 軟骨破損 J Bone Joint Surg Am. 2014 Aug 6;96(15):1273-1279. Median re

14、sidual 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.圖中圖中紅柱紅柱代表球囊復(fù)位代表球囊復(fù)位組

15、組，黑柱黑柱代表傳統(tǒng)撬撥復(fù)位代表傳統(tǒng)撬撥復(fù)位組組，結(jié)果結(jié)果：總體復(fù)位不良率總體復(fù)位不良率 球囊擴(kuò)張組球囊擴(kuò)張組小小于于 傳統(tǒng)撬撥復(fù)位組傳統(tǒng)撬撥復(fù)位組 Median stiffness and yield load during static loading of fourteen specimens treated with an inflatable bone tamp (IBT) and fourteen contralateral specimens treated with conventional bone tamps (CBT). The dispersion bars repr- esent the interquartile range. .圖中圖中I黑柱黑柱代表球囊復(fù)位，代表球囊復(fù)位，紅柱紅柱代表傳統(tǒng)撬撥復(fù)位，代表傳統(tǒng)撬撥復(fù)位，結(jié)果結(jié)果：靜態(tài)負(fù)荷強(qiáng)度中靜態(tài)負(fù)荷強(qiáng)度中 剛度和屈服載荷 球囊擴(kuò)張組球囊擴(kuò)張組均強(qiáng)均強(qiáng)于于