胫骨平台后柱骨折的损伤机制、分型及治疗进展

目的 分析和总结胫骨平台后柱骨折的诊断和治疗进展.方法 本文拟通过检索近年来国内外研究胫骨平台后柱骨折的文献,汇总、归纳,探讨和分析胫骨平台后柱骨折的损伤机制、辅助检查和诊断、分型与治疗、内固定物进展等方面.结果 胫骨平台骨折是一种较为常见的关节内骨折.其中,胫骨平台后柱骨折在损伤机制和诊断治疗上,是一种特殊类型的平台骨折.后柱骨折主要累及胫骨内、外侧髁的后三分之一.传统分型方法不能准确分型,临床易漏诊.手术入路主要采用后侧入路(后正中入路、后外侧入路、后内侧入路),临床应用应掌握各入路指征,目前尚缺乏被广泛接受的胫骨平台后柱内固定材料.结论 胫骨平台后柱骨折在分型、手术入路、内固定材料选择上仍有争议,尤其是研制出符合胫骨平台后侧解剖学形态的内固定物是目前治疗胫骨平台后柱骨折的急切需求,制定手术方案、选择手术入路及内固定的选择上,应正确判断膝关节韧带和半月板损伤情况,充分考虑不同患者的个性化需求和各病例间不同的损伤机制、骨折类型及移位程度、软组织损伤情况.患者全身情况不同,制定的手术方案也不尽相同,以争取最好的临床疗效.

Injury mechanism,typing, and treatment progress of tibial plateau fracture of posterior column

Objective To analyze and summarize progress in the diagnosis and treatment oftibial plateau fracture of posterior column.Methods By retrieving research literatures on tibial plateau fracture of posterior column at home and abroad in recent years,this article summarized,concluded,explored,and analyzed injury mechanism,auxiliary examination and diagnosis,typing and treatment,internal fixation progress and so on of tibial plateau fracture of posterior column.Results Tibial plateau fracture was a common kind of intra-articular fracture.Among them,tibial plateau fracture of posterior column was a special type on injury mechanism,diagnosis and treatment.Posterior column fracture mainly involved back 1/3 of internal,lateral condyle of the tibia.Traditional typing methods were not quite accurate,leading to clinical missed diagnosis.Surgical approaches mainly were posterior approach (posterior midline approach,posterolateral and posteromedial approach),and doctors should master the approach indication in clinical application.There was still a lack of widely accepted tibial plateau posterior column internal fixation materials.Conclusions There were still controversies on typing,surgical approach,internal fixation materials selection of tibial plateau fracture of posterior column.Developing internal fixation materials that conformed to tibial plateau back anatomical morphology was an urgent demand in the treatment of tibial plateau fracture of posterior column.During making the operation plan,choosing surgical approach and internal fixation materials,doctors should correctly judge the injury situation of knee ligament and meniscus,fully consider individual needs of different patients and different injury mechanisms,fracture types,degrees of displacement,soft tissue injury situation.Surgery plans were not the same according to the general condition of different patients to strive for the best clinical curative effect.