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1、后外侧胫骨平台骨折,潘德悦,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？,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,胫前动脉ATA,腘动脉,不能结扎！,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,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,损伤机制,低能量损伤,屈曲,伸直,外
2、翻,内翻,过伸,影像学检查,X线CTMRICTA或动脉血管造影,分型,Schatzker 分型AO/OTA分型三柱分型Hohl-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,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,Zen
3、g BF.Three-column fixation for complex tibial plateau fractures.J Orthop Trauma.2010 Nov;24(11):683-92.,这是几型？,AO：41-B3 Schatzker：型 三柱：外侧+后侧柱,治疗,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 fractur
4、esJActa 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)：475484,前外侧入路,治疗,后正中入路,Hughston JC.A surgical approach to the medial and posterior ligaments of the knee.Clin Orthop R
5、elat Res 1973;91(91):2933,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.,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
6、 Orthop Relat Res.2013 Sep;471(9):2760-7.,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 ofisolated posterior coronal fracture of the lateral tibial plateau throughposterolateral approach for direct exposure and buttress plate fixation.ArchOrthop Trauma Surg.2009 Jul;12
7、9(7):955-62,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 fixation.ArchOrthop Trauma Surg.2009 Jul;129(7):955-62,后外侧骨折-后外侧切口入路,后外侧骨折-前外侧扩大切口入路,后外
8、侧骨折-后正中切口入路,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.,后外侧骨折-Carlson入路,Carlson DA.Posterior bicondylar tibial plateau fractures.J Orthop Trauma.2005 Feb;19(
9、2):73-8,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,经腓骨头上入路,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,后（外）侧入路优点直接复位可以有效固定,常见治疗方式,拉力螺钉锁定钢板普通钢板克氏针空心加压螺钉髓内钉
10、,内固定材料,治疗,后外侧骨折复位,经骨折线复位开窗截骨后（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.,内固定技术,Raft技术（竹筏或排钉技术）,Cross WW 3rd,Levy BA,Morgan JA,Armitage BM,C
11、ole 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 thejail tec
12、hnique: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 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,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。,术前CT,内侧切口,外侧切口,手术切口,术后复查,术后复查,谢谢！,
