后外侧胫骨平台骨折的解剖型钢板设计及可靠性评估

Tibial plateau fracture is a common intra-articular fracture, the posterolateral part of which has recently drawn more and more attention. With the advancement of three dimensional imaging techniques as well as the development of tibial plateau classification, the traditional impression of posterolateral tibial plateau fracture has been challenged. The incidence is actually higher than previously thought, especially in complex fractures. The reason why surgical approaches and fixation methods regarding posterolateral tibial plateau fracture remain controversial is not only because of its difficulty in soft tissue management compared with the posteromedial counterpart but also for lack of specifically designed posterolateral anatomic plate. Loss of reduction post-operative has been reported to affect the functional results. We plan to design a Chinese-oriented posterolateral tibial plateau plate based on the widely accepted Three-Column Theory and abundant clinical experience. To accomplish this, the plate design will be conceived by way of 3D model design at the first place. Data related with anatomic characteristics and morphological results formed the basis of our computerized design. Fine tuning will be based on the adhesion to the knee 3D model reconstructed by CT data. Next, three dimensional printers would manufacture the plate sample. In addition, cadaver anatomic study will be taken to find out the maneuverability and safety when applying the plate. For better understanding of the plate’s biomechanical characteristics, the plate will be produced as titanium alloy to using in the standardized artificial bone to verify its biomechanics, fracture model of different subtypes of posterolateral tibial plateau fracture would be made according to current data and statistics.In conclusion, the plate we plan to design may have two potential benefits. It will complete the implant family of tibial plateau fixation; the data collected through the experiments will provide reference and guidance for surgical approach. A standard management or protocol for posterolateral tibial plateau fracture maybe proposed from the results of this study.

胫骨平台骨折是临床上常见的下肢关节内骨折。随着影像技术的进步、骨折分型的改良，骨科医生对后外侧胫骨平台骨折的认识产生了巨大的变化：它的发生率并不低，尤多见于复杂型骨折；手术中易损伤重要的血管神经，且由于缺乏专属的内固定物，使得它现有的固定方式繁杂且不规范。我们意欲设计出适合国人解剖的胫骨平台后外侧钢板以解决现存的内固定选择争议，改善术后再塌陷率高的现状。为此，我们将借助积累的解剖学及形态学参数，通过三维设计软件创建出解剖型钢板，并在软件中与胫骨平台三维模型进行贴附并调整构型；进而应用三维打印技术，得到钢板塑料样品，在尸体上模拟手术探索钢板的解剖安全性；最后加工得到钛合金成品，验证钢板的生物力学可靠性。本研究填补了后外侧胫骨平台钢板设计上的空缺，完善后外侧的骨折内固定理念，对于解决充满争议的后外侧胫骨平台骨折、改善目前术后再塌陷率高等问题具有重要意义。

胫骨平台骨折是临床上常见的下肢关节内骨折。随着影像技术的进步、骨折分型的改良，骨科医生对后外侧胫骨平台骨折的认识产生了巨大的变化：它的发生率并不低，尤多见于复杂型骨折；手术中易损伤重要的血管神经，且由于缺乏专属的内固定物，使得它现有的固定方式繁杂且不规范。通过本研究，我们研究了胫骨平台的骨折线和塌陷区域分布——明确的骨折的三维形态学；建立了基于大样本胫骨平台骨折病例的三维模型库——可用于设计内固定及后续的量化评估；提出了基于损伤机制的骨折形态差异和手术策略差异——解决了现存的内固定选择争议。设计出了适合国人解剖形态的胫骨平台后外侧钢板——提供了可选的固定方案。本研究填补了后外侧胫骨平台钢板设计上的空缺，完善后外侧的骨折内固定理念，对于解决充满争议的后外侧胫骨平台骨折、改善目前术后再塌陷率高等问题具有重要意义。