后外側(cè)脛骨平臺(tái)骨折(行業(yè)運(yùn)用)課件

1、后外側(cè)脛骨平臺(tái)骨折潘德悅1醫(yī)療醫(yī)學(xué)后外側(cè)脛骨平臺(tái)骨折潘德悅1醫(yī)療醫(yī)學(xué)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？2醫(yī)療醫(yī)學(xué)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2醫(yī)后外側(cè)3醫(yī)療醫(yī)學(xué)后外側(cè)3醫(yī)療醫(yī)學(xué) 后外側(cè)脛骨平臺(tái)4醫(yī)療醫(yī)學(xué) 后外側(cè)脛骨平臺(tái)4醫(yī)療醫(yī)學(xué)解剖5醫(yī)療醫(yī)學(xué)解剖5醫(yī)療醫(yī)學(xué)解剖6醫(yī)療醫(yī)學(xué)解剖6醫(yī)療醫(yī)學(xué)解剖A：46.39.0mmB：35.79.0mm后側(cè)血管脛前動(dòng)脈ATA腘動(dòng)脈不能結(jié)扎！7醫(yī)療醫(yī)學(xué)解剖A：46.39.0mm后側(cè)血管脛前動(dòng)脈ATA腘動(dòng)脈不能解剖后外側(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8

2、醫(yī)療醫(yī)學(xué)解剖后外側(cè)復(fù)合體！維持膝關(guān)節(jié)后外側(cè)穩(wěn)定8醫(yī)療醫(yī)學(xué)解剖外翻角：87 （85-90） 后傾角：0-10Cong-Feng Luo.Reference axes for reconstruction of the knee. The Knee 2004, 11:253-2579醫(yī)療醫(yī)學(xué)解剖外翻角：87 Cong-Feng Luo.Refe損傷機(jī)制低能量損傷屈曲伸直外翻內(nèi)翻過(guò)伸10醫(yī)療醫(yī)學(xué)損傷機(jī)制低能量損傷屈曲伸直外翻內(nèi)翻過(guò)伸10醫(yī)療醫(yī)學(xué)影像學(xué)檢查X線CTMRICTA或動(dòng)脈血管造影11醫(yī)療醫(yī)學(xué)影像學(xué)檢查X線11醫(yī)療醫(yī)學(xué)分型Schatzker 分型AO/OTA分型三柱分型Hohl-Moore分型

3、12醫(yī)療醫(yī)學(xué)分型Schatzker 分型12醫(yī)療醫(yī)學(xué)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):94-104.13醫(yī)療醫(yī)學(xué)Schatzker 分型Schatzker J, McBroAO/OTA分型關(guān)節(jié)外骨折(Type A)單髁骨折(Type B)雙髁骨折(TyPe C)14醫(yī)療醫(yī)學(xué)AO/OTA分型關(guān)節(jié)外骨折(Type A)14醫(yī)療醫(yī)學(xué)三柱分型

4、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醫(yī)療醫(yī)學(xué)三柱分型Luo CF, Sun H, Zhang B, Ze這是幾型？AO ： 41-B3 Schatzker：型 三柱：外側(cè)+后側(cè)柱 16醫(yī)療醫(yī)學(xué)這是幾型？AO ： 41-B3 Schatz治療17醫(yī)療醫(yī)學(xué)治療17醫(yī)療醫(yī)學(xué)關(guān)節(jié)塌陷和分離3 mm干骺端明顯移位或成角5開(kāi)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

5、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 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,2006,37(6)：47548418醫(yī)療醫(yī)學(xué)關(guān)

6、節(jié)塌陷和分離3 mm治療手術(shù)治療指征1.Thomas C前外側(cè)入路治療19醫(yī)療醫(yī)學(xué)前外側(cè)入路治療19醫(yī)療醫(yī)學(xué)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):293320醫(yī)療醫(yī)學(xué)后正中入路Hughston JC. A surgical a倒L入路Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plate

7、au fractures. J Orthop Trauma. 2010 Nov;24(11):683-92.21醫(yī)療醫(yī)學(xué)倒L入路Luo CF, Sun H, Zhang B, Ze擴(kuò)大 Tscherne-Johnson 入路治療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醫(yī)療醫(yī)學(xué)擴(kuò)大 Tscherne-Johnso

8、n 入路治療Johnso后外側(cè)骨折后外側(cè)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;129(7):955-6223醫(yī)療醫(yī)學(xué)后外側(cè)骨折后

9、外側(cè)切口入路Chang SM, ZheChang 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后外側(cè)骨折后外側(cè)切口入路24醫(yī)療醫(yī)

10、學(xué)Chang SM, Zheng HP, Li HF, Jia后外側(cè)骨折前外側(cè)擴(kuò)大切口入路25醫(yī)療醫(yī)學(xué)后外側(cè)骨折前外側(cè)擴(kuò)大切口入路25醫(yī)療醫(yī)學(xué)后外側(cè)骨折后正中切口入路26醫(yī)療醫(yī)學(xué)后外側(cè)骨折后正中切口入路26醫(yī)療醫(yī)學(xué)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 treatment of lateral or posterolateral tibial plateau fractures.Knee. 2010 Oct;17(5):313-8.

11、27醫(yī)療醫(yī)學(xué)后外側(cè)骨折腓骨頭截骨入路 Yu B, Han K,后外側(cè)骨折Carlson入路Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthop Trauma.2005 Feb;19(2):73-828醫(yī)療醫(yī)學(xué)后外側(cè)骨折Carlson入路Carlson DA.Frosch KH, Balcarek P, Walde T, Strmer KM. A new posterolateral approachwithout fibula osteotomy for the treatment of tibial plate

12、au fractures. J Orthop Trauma. 2010 Aug;24(8):515-20.后外側(cè)骨折Frosch入路29醫(yī)療醫(yī)學(xué)Frosch KH, Balcarek P, Walde T經(jīng)腓骨頭上入路30醫(yī)療醫(yī)學(xué)經(jīng)腓骨頭上入路30醫(yī)療醫(yī)學(xué)后（外）側(cè)入路問(wèn)題暴露困難，易損傷血管神經(jīng)復(fù)位困難，無(wú)法直視關(guān)節(jié)面力線糾正不足31醫(yī)療醫(yī)學(xué)后（外）側(cè)入路問(wèn)題31醫(yī)療醫(yī)學(xué)后（外）側(cè)入路優(yōu)點(diǎn)直接復(fù)位可以有效固定32醫(yī)療醫(yī)學(xué)后（外）側(cè)入路優(yōu)點(diǎn)32醫(yī)療醫(yī)學(xué)常見(jiàn)治療方式33醫(yī)療醫(yī)學(xué)常見(jiàn)治療方式33醫(yī)療醫(yī)學(xué)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34醫(yī)療醫(yī)學(xué)拉力螺釘內(nèi)固定材料治療

13、34醫(yī)療醫(yī)學(xué) 后外側(cè)骨折復(fù)位經(jīng)骨折線復(fù)位開(kāi)窗截骨后（外）側(cè)入路35醫(yī)療醫(yī)學(xué) 后外側(cè)骨折復(fù)位經(jīng)骨折線復(fù)位35醫(yī)療醫(yī)學(xué)經(jīng)骨折線復(fù)位36醫(yī)療醫(yī)學(xué)經(jīng)骨折線復(fù)位36醫(yī)療醫(yī)學(xué) 后外側(cè)骨折常見(jiàn)固定方式37醫(yī)療醫(yī)學(xué) 后外側(cè)骨折常見(jiàn)固定方式37醫(yī)療醫(yī)學(xué) 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

14、-8.38醫(yī)療醫(yī)學(xué) Zhang W, Luo CF, Putnis S, Su39醫(yī)療醫(yī)學(xué)39醫(yī)療醫(yī)學(xué)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 constructs and fracture stability in split-depression tibial plateau fractures.Injury. 2013 Jun;44(6):796-801.40醫(yī)療醫(yī)學(xué)內(nèi)固定技術(shù)Raft技術(shù) Cross WW 3rd, LevyJAIL（網(wǎng)格

15、）技術(shù) Weimann A, Heinkele T, Herbort M, Schliemann B, Petersen W, Raschke MJ.Minimally invasive reconstruction 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)41醫(yī)療醫(yī)學(xué)JAIL（網(wǎng)格）技術(shù) Weimann A, Heinkele經(jīng)皮內(nèi)固定技術(shù)This new techniq

16、ue is recommended for fractures with cleavage and compression or only compression42醫(yī)療醫(yī)學(xué)經(jīng)皮內(nèi)固定技術(shù)This new technique is r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 of a Cadaver Model. J Bone Joint Surg Am. 2014 Aug 6;96(15):1273-1279VS43醫(yī)療醫(yī)學(xué)球囊復(fù)位技術(shù)Heiney JP, Kurs