摘要
背景:胫骨平台后外侧骨折因其所处位置解剖关系复杂,在手术入路选取、内固定策略制定中常常存在一些争论问题。此外,随着3D打印技术在临床工作中的开展,对胫骨平台后外侧骨折手术治疗产生了一些积极的影响。目的:对近年来胫骨平台后外侧骨折手术入路、内固定策略、3D打印技术方面的研究进展进行总结和展望。方法:第一作者以中英文检索词在Web of Science、PubMed和中国知网(CNKI)数据库中检索2011年5月至2020年5月收录的相关文献,中英文检索词分别为"胫骨平台,后外侧,骨折,手术入路,内固定,3D打印"和"tibial plateau,posterolateral,fracture,approach,internal fixation,3D printing"。将检索出的文献进行筛选整理,并对入选文献展开详细综述。结果与结论:(1)胫骨平台后外侧骨折手术入路主要为不经截骨入路和经截骨入路,其中不经截骨入路种类较多;(2)后外侧入路为胫骨平台后外侧骨折的直接入路,而其周围解剖结构相对复杂;外侧、前外侧可处理合并前外侧平台骨折且前外侧入路不涉及重要血管神经,后正中入路可显露整个后方平台;后内侧入路可为胫骨平台后外侧骨折的辅助入路,若联合前外侧入路可显露近乎整个胫骨平台;(3)经截骨入路虽可增大术野,但也面临截骨并发症问题;(4)内固定材料种类较多且各有特色,内固定方式也得到了一定改进;(5)3D打印技术便于胫骨平台后外侧骨折手术入路和内固定策略的制定,以及内固定材料和方式的生物力学研究测试;(6)今后,针对胫骨平台后外侧骨折问题仍需达成一致性最优化的手术入路标准,新式的内固定材料不但需要生物力学方面的测试,而且尚需大量临床应用效果分析。
BACKGROUND:For posterolateral tibial plateau fracture due to the complex anatomical relationship of its location,there are often some controversial issues in choice of surgical approach and internal fixation strategy.In addition,with the development of three-dimensional(3D)printing technique in clinical work,it has had a positive impact on surgical treatment of posterolateral tibial plateau fracture.OBJECTIVE:To summarize and prospect the research progress of surgical treatment of posterolateral tibial plateau fracture in surgical approach,internal fixation strategy and 3D printing technique in recent years.METHODS:The first author used Chinese and English search terms to search the relevant literature collected in the Web of Science,PubMed and CNKI databases from May 2011 to May 2020.The keywords were"tibial plateau,posterolateral,fracture,approach,internal fixation,3D printing"in English and Chinese.The relevant literature was screened and sorted out,and conducted a detailed review.RESULTS AND CONCLUSION:(1)Surgical approaches of posterolateral tibial plateau fracture are mainly non-osteotomy and trans-osteotomy,of which there are many types of non-osteotomy.(2)The posterolateral approach is a direct approach,and the surrounding anatomical structure is relatively complex.Lateral and anterolateral sites can be treated with anterolateral tibial plateau fracture and the anterolateral approach does not involve important blood vessel and nerves.The posterior median approach can reveal the entire posterior tibial plateau.The posteromedial approach can be an auxiliary approach.If combined with the anterior-lateral approach,it can reveal almost the entire tibial plateau.(3)Although the osteotomy approach can increase the surgical field,it carries the complications.(4)There are many types of internal fixation materials with their own characteristics,and internal fixation method has also been improved.(5)3D printing technique facilitates the formulation of surgical approaches and internal fixation strategies as well as r
作者
王德斌
毕郑刚
Wang Debin;Bi Zhenggang(Department of Orthopedics,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,Heilongjiang Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2021年第12期1904-1910,共7页
Chinese Journal of Tissue Engineering Research
关键词
骨
胫骨
胫骨平台
骨折
截骨
内固定
3D打印
bone
tibia
tibial plateau
fracture
osteotomy
internal fixation
3D printing
