1、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?1后外侧胫骨平台骨折2022-11-2后外侧2后外侧胫骨平台骨折2022-11-2 后外侧胫骨平台3后外侧胫骨平台骨折2022-11-2解剖4后外侧胫骨平台骨折2022-11-2解剖5后外侧胫骨平台骨折2022-11-2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!6后外侧胫骨平台骨折2022-11-2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
2、带弓状韧带弓状韧带后外侧关节囊后外侧关节囊7后外侧胫骨平台骨折2022-11-2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 of the knee.The Knee 2004,11:253-2578后外侧胫骨平台骨折2022-11-2损伤机制低能量损伤屈曲伸直外翻内翻过伸9后外侧胫骨平台骨折2022-11-2影像学检查 X线 CT MRI CTA或动脉血管造影10后外侧胫骨平台骨折2022-11-2分型Schatzker 分型AO/OTA分型三柱分型Hohl-Moore分型11后
3、外侧胫骨平台骨折2022-11-2Schatzker 分型Schatzker J,McBroom R,Bruce D.The tibial plateau fracture.The Torontoexperience 1968-1975.Clin Orthop Relat Res.1979 Jan-Feb;(138):94-104.12后外侧胫骨平台骨折2022-11-2AO/OTA分型关节外骨折(Type A)单髁骨折(Type B)双髁骨折(TyPe C)13后外侧胫骨平台骨折2022-11-2三柱分型Luo CF,Sun H,Zhang B,Zeng BF.Three-column fi
4、xation for complex tibial plateau fractures.J Orthop Trauma.2010 Nov;24(11):683-92.14后外侧胫骨平台骨折2022-11-2这是几型?AO:41-B3 Schatzker:型 三柱:外侧+后侧柱 15后外侧胫骨平台骨折2022-11-2治疗16后外侧胫骨平台骨折2022-11-2 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 屈膝不稳治疗手术治疗指征1.Thomas C,Athanasiov A,Wullschleger M,et a1Current conc
5、epts 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):47548417后外侧胫骨平台骨折2022-11-2前外侧入路前外侧入路治疗18后外侧胫骨平台骨折2022-11-2后正中入路后正中入路Hughston JC.A surgi
6、cal approach to the medial and posterior ligaments of the knee.Clin Orthop Relat Res 1973;91(91):293319后外侧胫骨平台骨折2022-11-2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):683-92.20后外侧胫骨平台骨折2022-11-2扩大扩大 Tscherne-Johnson 入路入
7、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):2760-7.21后外侧胫骨平台骨折2022-11-2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 frac
8、ture of the lateral tibial plateau throughposterolateral approach for direct exposure and buttress plate fixation.ArchOrthop Trauma Surg.2009 Jul;129(7):955-6222后外侧胫骨平台骨折2022-11-2Chang SM,Zheng HP,Li HF,Jia YW,Huang YG,Wang X,Yu GR.Treatment ofisolated posterior coronal fracture of the lateral tibia
9、l plateau throughposterolateral approach for direct exposure and buttress plate fixation.ArchOrthop 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23后外侧胫骨平台骨折2022-11-2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24后外侧胫骨平台骨折2022-11-2后外侧骨折后外侧骨折-后正中切口入路后正中切口入路25后外侧胫骨平台骨折2022-11-2后外侧骨折后外侧骨折-腓骨头截骨入路腓骨头截骨入路 Y
10、u 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):313-8.26后外侧胫骨平台骨折2022-11-2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)
11、:73-827后外侧胫骨平台骨折2022-11-2Frosch 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.后外侧骨折后外侧骨折-Frosch入路入路28后外侧胫骨平台骨折2022-11-2经腓骨头上入路经腓骨头上入路29后外侧胫骨平台骨折2022-11-2后(外)侧入路问题n 暴露困难,易损伤血管神经
12、n 复位困难,无法直视关节面n 力线纠正不足30后外侧胫骨平台骨折2022-11-2后(外)侧入路优点n 直接复位n 可以有效固定31后外侧胫骨平台骨折2022-11-2常见治疗方式32后外侧胫骨平台骨折2022-11-2 拉力螺钉拉力螺钉 锁定钢板锁定钢板 普通钢板普通钢板 克氏针克氏针 空心加压螺钉空心加压螺钉 髓内钉髓内钉内固定材料治疗33后外侧胫骨平台骨折2022-11-2 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34后外侧胫骨平台骨折2022-11-2经骨折线复位35后外侧胫骨平台骨折2022-11-2 后外侧骨折常见固
13、定方式36后外侧胫骨平台骨折2022-11-2 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):94-8.37后外侧胫骨平台骨折2022-11-238后外侧胫骨平台骨折2022-11-2内固定技术Raft技术(竹筏或排钉技术)Cross WW 3rd,Levy BA,Morgan JA,Armitag
14、e BM,Cole PA.Periarticular raft constructs and fracture stability in split-depression tibial plateau fractures.Injury.2013 Jun;44(6):796-801.39后外侧胫骨平台骨折2022-11-2JAIL(网格)技术 Weimann A,Heinkele T,Herbort M,Schliemann B,Petersen W,Raschke MJ.Minimally invasive reconstruction of lateral tibial plateau fr
15、actures using thejail technique:a biomechanical study.BMC Musculoskelet Disord.2013 Apr4;14:120.内固定技术40后外侧胫骨平台骨折2022-11-2经皮内固定技术This new technique is recommended for fractures with cleavage and compression or only compression41后外侧胫骨平台骨折2022-11-2球囊复位技术Heiney JP,Kursa K,Schmidt AH,Stannard JP.Reductio
16、n 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):1273-127942后外侧胫骨平台骨折2022-11-2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。43后外侧胫骨平台骨折2022-11-244后外侧胫骨平台骨折2022-11-2内侧切口内侧切口外侧切口外侧切口45后外侧胫骨平台骨折2022-11-246后外侧胫骨平台骨折2022-11-247后外侧胫骨平台骨折2022-11-248后外侧胫骨平台骨折2022-11-2