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1、适应症：胫骨平台后外侧骨折体位：为显露胫骨近端后外侧和上胫腓关节，可将病人置于俯卧位或侧卧位。解剖特征:职机111肠内侧戊州腓肠肌外服曲二头肌rww半慣肌股前肌膊总神经曜下内侧动脉itM-mraBk內侧功眛切口：弧形切口近端位于股二头肌肌腱上方，绕过近端腓骨稍向内侧弯曲。m. biceps Omoristract us iliotibialislateral head ollha m.gastrocnemiusm. so（sus上图示：黑虚线为手术切口。An approximately 15-cm-long posterolateral skin incision is required （黑
2、虚线）.The fibula head is used as an an atomic lan dmark. The incision starts 3 cm above the joint line and follows the fibula in a distal directi on. To avoid scar con tracti ons, care must be take n so that the in cisi on is not made too far dorsally. Before the popliteal fossa is dissected, a latera
3、l sta ndard arthrotomy is performed. The tractusiliotibialis is in cised from the dorsal side, and the dorsal fibers are det ached from the Gerdys t ubercle Thereafter, the lateral capsule is incised, and the ligamentummeniscotibiale is dissected approximately 2 mm away from its insertion in the tib
4、ia, parallel to the joint surface. Now the joint surface can be inspected from the lateral side. The entire lateral tibial plateau, including the postero-lateral corner, can be viewed by using this lateral arthrotomy, and the fracture can be assessed. Manipulation of the posterolateral fragments is
5、seldom successful using this lateral approach alone because both the fibula and the str ong ligame ntous and tendinous structures of the popliteal corner prevent direct reduction of the fragmen ts. Therefore, in most posterolateraltibial plateau fractures, an additional postero-lateral exposure of t
6、he fragments is necessary.Both approaches are performed through one skin in cisi on.After direct in cisi on of the fascia, the per on eal n erve is exposed to the rear edge of the M. biceps femoris. The n erve should be carefully dissected and gen tly mobilized for protecti on dur ing the operati on
7、. A blunt dissecti on of the popliteal fossa is in itially performed betwee n the lateral head of the M. gastroc nemius and the M. soleus, and the in specti on beg ins on the muscle belly of the M. soleus.After the blunt preparati on in the popliteal fossa, the A.and V. poplitea and the M. popliteus
8、 are exposed. The A. and V. poplitea are protected by the lateral head of the M.gastroc nemius, which is retracted by a Langenbeck retractor. The A. and V. genicularis inf. are ligated only if n ecessary. At the distal edge of the M. popliteus, a Langen beck hook is applied, and the muscle is pulled
9、 back toward the medial and cra nial directi on. Then, the M. soleus is carefully detached from the dorsal surface of the fibula. The soleus muscle should be detached distally un til the per on eal n erve at the fibular n eck en ters into the musculature. The per on eal n erve should not be dissecte
10、d after it enters into the musculature because muscle branches lead ing off in an atypical fashi on can be easily damaged. Further more, care must be taken so that small nerve branches innervating the M.soleus, which pen etrate the muscle at the cra nial edge, are not damaged. The muscle can be mobi
11、lized approximately 4 to 5 cm in the distal directi on. With a raspatory, soft tissue can be removed from fragments, which can be exposed in an L-shaped area at the dorsal side of the lateral tibial plateau.显露：1、辨认腓神经2、将腓肠肌外侧头向内侧牵开（必要时松解），自起点松解比目鱼 肌，腘肌腱可向近端内侧牵开或松解（缝合时需修复）。于半月板下行关节切开，松解半月板下方和腘肌腱裂孔内侧的冠状韧带，即可显露胫骨后外侧关节面。胫 骨后外侧的显露范围相对较小。m. gastrccnemaui （iat临d）peroneal nervedistalI业灿wm tsfflgfj日 fernorifi -M. biceps femorisA.山申lit品W. popliteuaM. SBKtnOCPITl! U Caput litsaleN. pGfDinseusM. sdIbusGaput fibulae
