治疗胫骨平台外侧髁的粉碎骨折(累及整个外侧、后外侧、前外侧),传统的解剖型钢板,仅能放在外侧髁的外侧面,其近端的横臂长度有限,至多能打入4枚水平方向螺钉,因包绕范围不足,部分骨折块难以得到有效固定。水平带状钢板(horizontal belt plate)的固定方式,是将较薄的直形钢板(如3.5 mm系列的1/3管型板、重建板、2.7 mm系列板等)经折弯后横向放置,或对较薄的T形钢板予以改造,剪去横臂的一边,再将其纵臂进行折弯后横向放置,如此则增加了水平方向的包绕范围,对破裂粉碎的关节面皮质边缘,以横向聚拢的方式对骨块进行支持固定,是近年来胫骨平台骨折治疗的重要进展。
In the treatment of comminuted fracture of lateral condyle of tibial plateau (involving the entire lateral, posterolateral, and anterolateral), traditional anatomical plate can only be placed on the lateral side of lateral condyle; the proximal arm length is limited for up to four horizontal screws; due to the lack of coverage, part of the fractures cannot be effectively fixed.The fixation with horizontal belt plates is bending straight thin plates and then placing horizontally (such as 3.5 mm 1/3 tube plate, reconstruction plate, and 2.7 mm plate), or modifying thin T-shaped plates by cutting off the side of transverse arm bending trailing arm, and placing horizontally.Such practice increases the coverage in horizontal direction of cracked articular surface.It is an important progress of lateral gather fixation in the treatment of tibial plateau fractures in recent years that it supports and fixes bone blocks in a horizontal manner.This article gave a summary on the topic.
[1] Luo CF, Sun H, Zhang B, et al.Three-column fixation for complex tibial plateau fractures[J].Orthop Trauma,2010,24(11):683-692.
[2] Wang YK, Luo C, Zhu Y, et al.Updated Three-Column Concept in surgical treatment for tibial plateau fractures - A prospective cohort study of 287 patients[J].Injury,2016,47(7):1488-1496.
[3] Chang SM.Selection of surgical approaches to the posterolateral tibial plateau fracture by its combination patterns[J].J Orthop Trauma,2011,25(3):e32-e33.
[4] Chang SM, Hu SJ, Zhang YQ, et al.A surgical protocol for bicondylar four-quadrant tibial plateau fractures[J].Int Orthop,2014,38(12):2559-2564.
[5] Li Q, Zhang YQ, Chang SM.Posterolateral fragment charac-teristics in tibial plateau fractures[J].Int Orthop,2014,38(3):681-682.
[6] Xiang G, Zhi P, Qiang Z, et al.Morphological characteristics of posterolateral articular fragments in tibial plateau fractures[J].Orthopedics,2013,36(10):e1256-1261.
[7] Bermudez CA, Ziran BH, Barrette-Grischow MK.Use of horizontal rafting plates for posterior elements of complex tibial plateau fractures:description and case reports[J].J Trauma,2008,65(5):1162-1167.
[8] Giordano V, Schatzker J, Kfuri M.The “hoop” plate for posterior bicondylar shear tibial plateau fractures: description of a new surgical technique[J].J Knee Surg,2017,30(6):509-513.
[9] 孙杰,魏学磊,李方国,等.胫骨平台外侧髁ABC骨折分型及治疗策略[J].中华骨科杂志, 2016,36(18):1167-1174.
[10] Cho JW, Samal P, Jeon YS, et al.Rim plating of posterolateral fracture fragments (PLFs)through a modified anterolateral approach in tibial plateau fractures[J].J Orthop Trauma,2016,30(11):e362-e368.
[11] Pires RES, Giordano V, Wajnsztejn A, et al.Complications and outcomes of the transfibular approach for posterolateral fractures of the tibial plateau[J].Injury,2016,47(10):2320-2325.
[12] 胡孙君,张世民.累及后外侧髁的胫骨平台骨折手术治疗[J].国际骨科学杂志, 2016,37(4):228-231.
[13] Hu SJ, Chang SM, Zhang YQ, et al.The anterolateral supra-fibular-head approach for plating posterolateral tibial plateau fractures:A novel surgical technique[J].Injury,2016,47(2):502-507.
[14] Doht S, Lehnert T, Frey S, et al.Effective combination of bone substitute and screws in the jail technique:a biomechanical study of tibial depression fractures[J].Int Orthop,2012,36(10):2121-2125.
[15] Weimann A, Heinkele T, Herbort M, et al.Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique:a biomechanical study[J].BMC Musculoskele Disord,2013,14(1):1-7.
[16] Vauclair F, Almasri M, Gallusser N, et al.Metaphyseal tibial level (MTL) screws:a modified percutaneous technique for lateral plateau depression fractures[J].Eur J Orthop Surg Traumatol,2015,25(5):963-967.
[17] Sun H, Zhu Y, He QF, et al.Reinforcement strategy for lateral rafting plate fixation in posterolateral column fractures of the tibial plateau:the magic screw technique[J].Injury,2017,48(12):2814-2826.
[18] Cho JW, Kim J, Cho WT, et al.Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures:a review with an emphasis on rim plating via modified anterolateral approach[J].Int Orthop,2017,41(9):1887-1897.