后外侧胫骨平台骨折(课堂PPT).ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,后外侧胫骨平台骨折,潘德悦,1,定义,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？,2,后外侧,3,后外侧胫骨平台,4,解剖,5,解剖,6,解剖,A,：,46.39.0mm,B,：,35.79.0mm,后侧血管,胫前动脉,ATA,腘动脉,不能结扎！,7,解剖,后外侧复合体！,（,PLC,）,维持膝关节后外侧稳定,外侧副韧带,腘肌腱复合体,腘腓韧带,弓状韧带,后外侧关节囊,8,解剖,外翻角：,87,（,85-90,）,后倾角：,0-10,Cong-Feng Luo,.,Reference axes for reconstruction of the knee.The Knee 2004,11:253-257,9,损伤机制,低能量损伤,屈曲,伸直,外翻,内翻,过伸,10,影像学检查,X,线,CT,MRI,CTA,或动脉血管造影,11,分型,Schatzker,分型,AO/OTA,分型,三柱分型,Hohl-Moore,分型,12,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):94-104.,13,AO/OTA分型,关节外骨折(,T,ype A),单髁骨折(,T,ype B),双髁骨折(,T,yPe C),14,三柱分型,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.,15,这是几型？,AO,：,41-B3,Schatzker：型 三柱：外侧,+,后侧柱,16,治疗,17,关节塌陷和分离3 mm,干骺端明显移位或成角5,开放性骨折合并血管神经损伤,出现骨筋膜间隔综合征等,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，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 a,l.,Complications after tibia plateau fracture surgery,J,.,Injury,2006,37(6)：475484,18,前外侧入路,治疗,19,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):2933,20,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.,21,扩大 Tscherne-Johnson 入路,治疗,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.,22,后外侧骨折,-,后外侧切口入路,Chang SM,Zheng HP,Li HF,Jia YW,Huang YG,Wang X,Yu GR.Treatment of,isolated posterior 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):955-62,23,Chang SM,Zheng HP,Li HF,Jia YW,Huang YG,Wang X,Yu GR.Treatment of,isolated posterior 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,后外侧骨折,-,后外侧切口入路,24,后外侧骨折,-,前外侧扩大切口入路,25,后外侧骨折,-,后正中切口入路,26,后外侧骨折,-,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 Oct;17(5):313-8.,27,后外侧骨折,-Carlson,入路,Carlson DA.Posterior bicondylar tibial plateau fractures.J Orthop Trauma.2005 Feb;19(2):73-8,28,Frosch KH,Balcarek P,Walde T,Strmer KM.A new posterolateral approachwithout fibula osteotomy for the treatment of tibial plateau fractures.J Orthop Trauma.2010 Aug;24(8):515-20.,后外侧骨折,-,Frosch入路,29,经腓骨头上入路,30,后（外）侧入路问题,暴露困难，易损伤血管神经,复位困难，无法直视关节面,力线纠正不足,31,后（外）侧入路优点,直接复位,可以有效固定,32,常见治疗方式,33,拉力螺钉,锁定钢板,普通钢板,克氏针,空心加压螺钉,髓内钉,内固定材料,治疗,34,后外侧骨折复位,经骨折线复位,开窗,截骨,后（外）侧入路,35,经骨折线复位,36,后外侧骨折常见固定方式,37,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.,38,39,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.,40,JAIL,（网格）技术,Weimann A,Heinkele T,Herbort M,Schliemann B,Petersen W,Raschke MJ.,Minimally invasive reconstruction of lateral tibial plateau fractures using the,jail technique:a biomechanical study.BMC Musculoskelet Disord.2013 Apr,4;14:120.,内固定技术,41,经皮内固定技术,This new technique is recommended for fractures with cleavage and compression or only compression,42,球囊复位技术,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 Joint Surg Am.2014 Aug 6;96(15):1273-1279,VS,43,病例分享,患者，男，,49,岁，,“,摔伤致右膝关节疼痛、活动受限,5,小时,”,入院。,查体：右膝肿胀，无皮肤破溃，可见瘀斑，皮肤张力可，右膝外侧压痛明显,，右下肢触痛觉正常,，右膝屈伸活动因痛受限，右足背动脉搏动良好。,44,术前,CT,45,内侧切口,外侧切口,手术切口,46,术后复查,47,术后复查,48,谢谢！,49,