后外侧胫骨平台骨折ppt课件.pptx

1、后外侧 后外侧胫骨平台解剖解剖解剖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带弓状韧带弓状韧带后外侧关节囊后外侧关节囊外翻角：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, 11:253-257屈曲伸直外翻内翻过伸Schatzker J, McBroom R, Br

2、uce D. The tibial plateau fracture. The Torontoexperience 1968-1975. Clin Orthop Relat Res. 1979 Jan-Feb;(138):94-104.AO/OTA分型关节外骨折(Type A)单髁骨折(Type B)双髁骨折(TyPe C)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.

3、AO ： 41-B3 Schatzker：型 三柱：外侧+后侧柱 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)：3633732.Papagelopoulos PJ,Partsinevelos AA,Themistocleous GS,et al.Complications after tibia plateau fracture surgeryJ.Injury,2

4、006,37(6)：475484前外侧入路前外侧入路治疗后正中入路后正中入路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.

5、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.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 fracture of

6、the lateral tibial plateau throughposterolateral approach for direct exposure and buttress plate fixation. ArchOrthop Trauma Surg. 2009 Jul;129(7):955-62Chang SM, Zheng HP, Li HF, Jia YW, Huang YG, Wang X, Yu GR. Treatment ofisolated posterior coronal fracture of the lateral tibial plateau throughpo

7、sterolateral 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后外侧骨折后外侧骨折-后正中切口入路后正中切口入路后外侧骨折后外侧骨折-腓骨头截骨入路腓骨头截骨入路 Yu B, Han K, Zhan C, Zhang C, Ma H, Su J. Fibular head osteotomy: a new approa

8、ch for the treatment of lateral or posterolateral tibial plateau fractures.Knee. 2010 Oct;17(5):313-8.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):73-8后外侧骨折后外侧骨折-Frosch入路入路经腓骨头上入路经腓骨头上入路后（外）侧入路优点n 直接复位n 可以有效固定内固定材料治疗 后外侧骨折复位后外侧骨折复位 经

9、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）侧入路经骨折线复位 后外侧骨折常见固定方式 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.Raft技术（竹筏或排钉技术） Cross WW 3rd, Levy BA, Morgan JA, Armitage B

10、M, Cole PA. Periarticular raft constructs and fracture stability in split-depression tibial plateau fractures.Injury. 2013 Jun;44(6):796-801.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 t

11、hejail technique: a biomechanical study. BMC Musculoskelet Disord. 2013 Apr4;14:120.内固定技术经皮内固定技术This new technique is recommended for fractures with cleavage and compression or only compression球囊复位技术Heiney JP, Kursa K, Schmidt AH, Stannard JP. Reduction and Stabilization of Depressed Articular Tibia

12、l 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。内侧切口内侧切口外侧切口外侧切口