单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,2015,年,6,月,Balloon Tibioplasty:A Useful Tool for Reduction of Tibial Plateau Depression Fractures,球囊成形术治疗胫骨平台塌陷性骨折,导师：查振刚 教授,学生：顾容赫,2,Schatzker type,3,The common fracture patterns encountered are split depression(OTA Type B3,Schatzker Type II)and lateral depression(OTA type B2,Schatzker type III).They prevailing in elderly patients due to osteopenia or osteoporosis,。,Schatzker II,Schatzker III,胫骨平台常见的,Schatzker type,II,/III,骨折多见于,骨质减少或骨质疏松,的老年人,。,Backgrounds,Numerous techniques have been described to treat depressed tibial plateau fractures.With all techniques,the depression needs to be elevated mechanically with the use of metallic instruments through bone windows,.,传统方法：,切开在关节面塌陷下方开窗,+,金属棒撬拨,+,植骨填充,+,钢板内固定,Backgrounds,Backgrounds,As we know,percutaneous vertebroplasty,（,PVP,）,with inflatable has been use in Compression vertebral fractures in Aged.,我们知道：,经皮椎体成形术已经广泛的用于治疗老年人压缩性椎体骨折。,Method,To minimize the diameter of the tibial bone window and to simultaneously increase the area of power transmission to elevate the depressed plateau,Pizanis used an inflatable kyphoplasty balloon as a reduction aid,。,为了减少胫骨的创伤及尽可能复位好塌陷的胫骨平台，德国的一位研究者使用球囊扩张骨水泥成形来复位胫骨塌陷性骨折。,Method,A fragment locking T-plate,balloon K-wires cortical screw,胫骨外侧锁定,T,形钢板,球囊,克氏针,皮质骨螺钉,A,、,75year-old man with displaced split depression type fracture in CT of the tibial plateau(Schatzker type II).,75,岁，男，胫骨平台骨折，,Schatzker,II,B,、,Tibial plateau fractures Arthroscopic,.,关节镜下胫骨平台,Schatzker II,骨折表现,A,B,Patients,Patients,A,、,A visual check under the lateral meniscus or an arthroscopic assessment of anatomic joint reduction completes the reduction procedure,扩张球囊上抬塌陷的平台时，同时直视或关节镜下观察胫骨平台复位情况。,B,、,X-ray after operation,.,术后,X,线表现,。,A,Method,J Bone Joint Surg Am.,2014 Aug 6;96(15):1273-1279.,Reduction and Stabilization of Depressed Articular Tibial Plateau Fractures:Comparison of Inflatable and Conventional Bone Tamps:Study of a Cadaver Model.,尸体上,C,臂透视下,两种,手,术方法,左图：,球囊扩张复位塌陷胫骨平台,右图,：,传统金属棒撬拨复位法,Fluoroscopic images illustrating the reduction On the right is the lateral cortical window with conventional tamp and on the left is the inflatable tamp.,The reduction quality,Photographs of the fractured lateral tibial plateau surfaces before,(Fig.1-A),and after(Fig.1-B)reduction with an inflatable tamp and before,(Fig.1-C),and after,(Fig.1-D),reduction with the conventional tamp on the contralateral side.,图,A/C,：胫骨平台压缩性骨折尸,体模型,图,B,:,球囊扩张复位后表面，,平滑,图,D,:,金属棒撬拨复位后表面，,粗糙,软骨破损,J Bone Joint Surg Am.,2014 Aug 6;96(15):1273-1279.,The reduction quality,Median residual defect volume expressed as a percentage of the depressed defect volume for fourteen specimens treated with an inflatable bone tamp(IBT)and fourteen contralateral specimens treated with conventional bone tamps(CBT).The dispersion bars represent the inter quartile range.,图中,红柱,代表球囊复位,组,，,黑柱,代表传统撬拨复位,组,，,结果,：,总体复位不良率,球囊扩张组,小,于,传统撬拨复位组,Conclusions,inflatable bone tamp had better reduction,：,1,、,smoother articular surface with less residual defect volume,2,、,exhibited less subsidence during cyclic loading and greater stiffness under static loading,谢谢,！,Thanks for your attention,