胫骨平台骨折的微创治疗

doi:10.3877/cma.j.issn.1674-134X.2025.04.010

胫骨平台骨折因胫骨近端皮肤菲薄，治疗可采用经皮微创方法以保护局部软组织，促进骨骼愈合。治疗前需通过详细的CT三维重建评估，精确判断骨折类型。治疗的主要目标是先恢复下肢对线，再精确复位关节面，恢复关节稳定性。手术导航和关节镜技术对于验证复位效果至关重要。骨折的稳定可通过骨水泥、空心螺钉或微创经皮钢板实现。经皮手术的关键在于保护干骺端的血管供应，而非切口大小，以确保愈合质量和长期稳定性。相比开放复位内固定，经皮手术不仅在SchatzkerⅠ、Ⅱ和Ⅲ型骨折中表现更好，在复杂骨折中也有应用，其具有创伤小的优势，可减少并发症。

关键词: 胫骨骨折, 治疗, 骨折固定术

Tibial plateau fracture is treated with percutaneous minimally invasive techniques to protect the local soft tissue and promote bone healing due to the thin skin of the proximal tibia. Detailed CT 3D reconstruction is required to accurately determine the type of fracture prior to treatment. The main goal of treatment is to restore the alignment of the lower limb, followed by precise repositioning of the articular surfaces and restoration of joint stability. Surgical navigation and arthroscopic techniques are essential to verify the effectiveness of the reduction. Fracture stabilisation can be achieved with bone cement, cannulated screws or minimally invasive percutaneous plates. The key to percutaneous surgery is to protect metaphyseal blood supply, not the size of the incision, to ensure quality of healing and long-term stability. Compared to open reduction, percutaneous surgery not only performs better in Schatzker type I, II, and III fractures, but also in complex fractures, where it has the advantage of being less invasive and reducing complications.

Key words: Tibial fractures, Treatment, Fracture fixation

图1 骨折分型示意图。图A为Schatzker分类；图B为胫骨平台三柱理论

Figure 1 Schematics of fracture typing. A is Schatzker classification; B is tibial plateau three-column theory

图2 基于CT图像构建个性化有限元模拟。图A为确定3.5 mm螺钉固定钢板时的应力分布；图B为确定4.5 mm螺钉固定钢板时的应力分布

Figure 2 Personalized finite element simulations construction based on the CT images. A is the image determining the stress distribution during the fixation of steel plates with screws of 3.5 mm; B is the image determining the stress distribution during the fixation of steel plates with screws of 4.5 mm

图3 膝关节MRI示胫骨平台形态。图A为胫骨平台内侧凹面；图B为外侧胫骨平台凸面

Figure 3 MRI of knee joint showing the shape of tibial plateau. A is medial concave surface of tibial plateau; B is convex surface of lateral tibial plateau

图4 Schatzker Ⅵ型骨折胫骨正侧位X线片。图A为术前胫骨X线片，示Schatzker Ⅵ型骨折；图B为使用微创钢板固定技术后胫骨X线片

Figure 4 Schatzker type Ⅵ fracture. A is X ray image at anteroposterior and lateral views of tibia; B is X ray image at anteroposterior and lateral views of tibia using minimally invasive percutaneous plate osteosynthesis

图5 胫骨平台骨折复位技巧透视下过程。图A示插入5 mm Steinmann针；图B示拔出Steinmann针后用T型手柄倒插指向骨折碎片；图C示完全升高凹陷的外侧平台

Figure 5 Tibial plateau fracture repositioning technique under X ray. A shows insertion of 5 mm Steinmann wire; B shows insertion of T-shape handle pointing to the fracture fragment after extraction of Steinmann wire; C shows full elevation of depressed lateral plateau

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Minimally invasive treatment of tibial plateau fractures

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Minimally invasive treatment of tibial plateau fractures