后外側(cè)脛骨平臺(tái)骨折

1、后外側(cè)脛骨平臺(tái)骨折,潘德悅,定義,脛骨平臺(tái)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(tái)的定義？,,后外側(cè),后外側(cè)脛骨平臺(tái),解剖,解剖,解剖,A：46.3±9.0mmB：35.7±9.0mm,后側(cè)血管,脛前動(dòng)脈ATA,腘動(dòng)脈,不能結(jié)扎！??！,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,解剖,外翻角：87

2、6; （85-90°） 后傾角：0-10°,Cong-Feng Luo.Reference axes for reconstruction of the knee. The Knee 2004, 11:253-257,損傷機(jī)制,低能量損傷,屈曲,伸直,外翻,內(nèi)翻,過伸,影像學(xué)檢查,X線CTMRICTA或動(dòng)脈血管造影,分型,Schatzker 分型AO/OTA分型三柱分型Ho

3、hl-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,關(guān)節(jié)外骨折(Type A)單髁骨折(Type B)雙髁骨折(TyPe C),

4、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.,這是幾型？,AO ： 41-B3 Schatzker：Ⅱ型 三柱：外側(cè)+后側(cè)柱,治療,關(guān)節(jié)塌陷和分離>3 mm干骺端明顯移位或

5、成角>5開放性骨折合并血管神經(jīng)損傷出現(xiàn)骨筋膜間隔綜合征等屈膝不穩(wěn)————單純后外側(cè)平臺(tái)骨折,治療,手術(shù)治療指征,1.Thomas C，Athanasiov A，Wullschleger M，et a1．Current concepts in tibial plateau fractures[J]．Acta Chir Orthop Traumatol Cech，2009，76(5)：363．373．2.Papagelopou

6、los PJ,Partsinevelos AA,Themistocleous GS,et al.Complications after tibia plateau fracture surgery[J].Injury,2006,37(6)：475—484．,前外側(cè)入路,治療,,后正中入路,Hughston JC. A surgical approach to the medial and posterior ligaments of t

7、he knee. Clin Orthop Relat Res 1973;91(91):29–33,,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):683-92.,擴(kuò)大 Tscherne-Johnson 入路,治療,Johns

8、on 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.,,后外側(cè)骨折-----后外側(cè)切口入路,Chang SM, Zheng HP, Li HF, Jia YW, Huang YG

9、, Wang X, Yu GR. Treatment ofisolated posterior coronal fracture of the lateral tibial plateau throughposterolateral approach for direct exposure and buttress plate fixation. ArchOrthop Trauma Surg. 2009 Jul;129(7):95

10、5-62,,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 direct exposure and buttress plate fixa

11、tion. ArchOrthop Trauma Surg. 2009 Jul;129(7):955-62,后外側(cè)骨折-----后外側(cè)切口入路,,后外側(cè)骨折-----前外側(cè)擴(kuò)大切口入路,,后外側(cè)骨折-----后正中切口入路,,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 new approach for the

12、treatment of lateral or posterolateral tibial plateau fractures.Knee. 2010 Oct;17(5):313-8.,,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,,Frosch KH,

13、Balcarek P, Walde T, Stürmer KM. A new posterolateral approachwithout 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,,經(jīng)腓骨頭上入路,,后（外）側(cè)入路問題暴

14、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,,后（外）側(cè)入路優(yōu)點(diǎn)直接復(fù)位可以有效固定,常見治療方式,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,后外側(cè)骨折復(fù)位,經(jīng)骨折線復(fù)位開窗截骨后（外）側(cè)入路,,經(jīng)骨折線復(fù)位,,后外側(cè)骨折常見固定方式,,Zhang W, Luo CF, Putnis S, Sun H, Zeng ZM, Zeng BF. Biomechanical an

15、alysis of four different fixations for the posterolateral shearing tibial plateau fracture.Knee. 2012 Mar;19(2):94-8.,,√,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, Armitage BM, Cole PA. Periarticular raft

16、constructs and fracture stability in split-depression tibial plateau fractures.Injury. 2013 Jun;44(6):796-801.,JAIL（網(wǎng)格）技術(shù),Weimann A, Heinkele T, Herbort M, Schliemann B, Petersen W, Raschke MJ.Minimally invasive reconst

17、ruction of lateral tibial plateau fractures using thejail technique: a biomechanical study. BMC Musculoskelet Disord. 2013 Apr4;14:120.,內(nèi)固定技術(shù),,經(jīng)皮內(nèi)固定技術(shù),This new technique is recommended for fractures with cleavage and c

18、ompression or only compression,,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