Garner Matthew R, Warner Stephen J, Lorich Dean G
Orthopaedic Trauma, Harborview Medical Center, Seattle, Washington.
Orthopaedic Trauma, Hospital for Special Surgery and New York Presbyterian Hospital, New York, New York.
J Knee Surg. 2016 Jan;29(1):12-20. doi: 10.1055/s-0035-1564731. Epub 2015 Oct 19.
Tibial plateau fractures involving the posterolateral articular surface present a unique challenge to treating surgeons due to the complex anatomy of the region. The posterolateral corner complex and the proximity of the common peroneal nerve restrict both the exposure of the joint surface and the ability to distract across the joint using a varus force. Further, injury to the soft tissue envelope may prevent use of the optimal surgical incision. For these reasons, a thorough understanding of the anatomy and available approaches is essential when treating these fractures. Approach selection should be based on fracture pattern, the surrounding soft tissue envelope, and the patient's clinical conditions; concomitant injuries and overall health status must be accounted for. In this article, we highlight five surgical approaches that can be utilized to improve visualization and access to the posterolateral tibial plateau. These include three separate osteotomies performed through an anterolateral approach: lateral femoral epicondyle osteotomy, fibular head resection osteotomy, and a novel digastric fibular osteotomy. In addition, we will discuss a posterolateral approach and a direct posterior approach.
由于该区域解剖结构复杂，累及后外侧关节面的胫骨平台骨折给外科医生的治疗带来了独特挑战。后外侧角复合体以及腓总神经的毗邻关系，限制了关节面的显露以及使用内翻力在关节处进行撑开的能力。此外，软组织包膜损伤可能会妨碍最佳手术切口的使用。出于这些原因，在治疗这些骨折时，深入了解解剖结构和可用的手术入路至关重要。手术入路的选择应基于骨折类型、周围软组织包膜以及患者的临床情况；必须考虑合并损伤和整体健康状况。在本文中，我们重点介绍五种可用于改善对胫骨平台后外侧的可视化和显露的手术入路。其中包括通过前外侧入路进行的三种不同截骨术：外侧股骨髁上截骨术、腓骨头切除术、一种新型的二腹肌腓骨截骨术。此外，我们还将讨论一种后外侧入路和一种直接后方入路。
