后外侧胫骨平台骨折

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：46.3±9.0mmB：35.7±9.0mm后侧血管胫前动脉ATA腘动脉解剖后外侧复合体！！！（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-FengLuo.Referenceaxesforreconstructionoftheknee.TheKnee2004,11:253-257损伤机制低能量损伤屈曲伸直外翻内翻过伸影像学检查•X线•CT•MRI•CTA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SchatzkerJ,McBroomR,BruceD.Thetibialplateaufracture.TheTorontoexperience1968--1975.ClinOrthopRelatRes.1979Jan-Feb;(138):94-104.AO/OTA分型关节外骨折(TypeA)单髁骨折(TypeB)双髁骨折(TyPeC)三柱分型LuoCF,SunH,ZhangB,ZengBF.Three-columnfixationforcomplextibialplateaufractures.JOrthopTrauma.2010Nov;24(11):683-92.这是几型？AO：41-B3Schatzker：Ⅱ型三柱：外侧+后侧柱治疗•关节塌陷和分离3mm•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.ThomasC，AthanasiovA，WullschlegerM，eta1．Currentconceptsintibialplateaufractures[J]．ActaChirOrthopTraumatolCech，2009，76(5)：363．373．2.PapagelopoulosPJ,PartsinevelosAA,ThemistocleousGS,etal.Complicationsaftertibiaplateaufracturesurgery[J].Injury,2006,37(6)：475—484．前外侧入路治疗后正中入路HughstonJC.Asurgicalapproachtothemedialandposteriorligamentsoftheknee.ClinOrthopRelatRes1973;91(91):29–33倒L入路LuoCF,SunH,ZhangB,ZengBF.Three-columnfixationforcomplextibialplateaufractures.JOrthopTrauma.2010Nov;24(11):683-92.扩大Tscherne-Johnson入路治疗JohnsonEE,TimonS,OsujiC.Surgicaltechnique:Tscherne-Johnsonextensileapproachfortibialplateaufractures.ClinOrthopRelatRes.2013Sep;471(9):2760-7.后外侧骨折-----后外侧切口入路ChangSM,ZhengHP,LiHF,JiaYW,HuangYG,WangX,YuGR.Treatmentofisolatedposteriorcoronalfractureofthelateraltibialplateauthroughposterolateralapproachfordirectexposureandbuttressplatefixation.ArchOrthopTraumaSurg.2009Jul;129(7):955-62ChangSM,ZhengHP,LiHF,JiaYW,HuangYG,WangX,YuGR.Treatmentofisolatedposteriorcoronalfractureofthelateraltibialplateauthroughposterolateralapproachfordirectexposureandbuttressplatefixation.ArchOrthopTraumaSurg.2009Jul;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侧骨折-----后正中切口入路后外侧骨折-----腓骨头截骨入路YuB,HanK,ZhanC,ZhangC,MaH,SuJ.Fibularheadosteotomy:anewapproachforthetreatmentoflateralorposterolateraltibialplateaufractures.Knee.2010Oct;17(5):313-8.后外侧骨折-----Carlson入路CarlsonDA.Posteriorbicondylartibialplateaufractures.JOrthopTrauma.2005Feb;19(2):73-8FroschKH,BalcarekP,WaldeT,StürmerKM.Anewposterolateralapproachwithoutfibulaosteotomyforthetreatmentoftibialplateaufractures.JOrthopTrauma.2010Aug;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ZhangW,LuoCF,PutnisS,SunH,ZengZM,ZengBF.Biomechanicalanalysisoffourdifferentfixationsfortheposterolateralshearingtibialplateaufracture.Knee.2012Mar;19(2):94-8.内固定技术Raft技术（竹筏或排钉技术）CrossWW3rd,LevyBA,MorganJA,ArmitageBM,ColePA.Periarticularraftconstructsandfracturestabilityinsplit-depressiontibialplateaufractures.Injury.2013Jun;44(6):796-801.JAIL（网格）技术WeimannA,HeinkeleT,HerbortM,SchliemannB,PetersenW,RaschkeMJ.Minimallyinvasivereconstructionoflateraltibialplateaufracturesusingthejailtechnique:abiomechanicalstudy.BMCMusculoskeletDisord.2013Apr4;14:120.内固定技术经皮内固定技术Thisnewtechniqueisrecommendedforfractureswithcleavageandcompressionoronlycompression球囊复位技术HeineyJP,KursaK,SchmidtAH,StannardJP.ReductionandStabilizationofDepressedArticularTibialPlateauFractures:ComparisonofInflatableandConventionalBoneTamps:StudyofaCadaverModel.JBoneJointSurgAm.2014Aug6;96(15):1273-1279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。内侧切口外侧切口