胫骨髁间棘撕脱骨折.ppt

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1、胫骨髁间棘撕脱骨折宫月明分型Meyers和McKeever分型III型I型：骨折无移位或前缘的轻度移位；II型：骨折前方部分移位，后方铰链侧完整，成鸟嘴状；III型：完全移位，3a仅累及acl止点；3b整个髁间棘注：Meyers-Mckeever-Zaricznyj分型将3b详细叙述，单独分出为Ⅳ型。（Ⅳ型：分层碎裂骨折，完全抬起并翻转）Themodifiedclassificationoftibialintercondylareminencefracture.（改良的Meyers–McKeever分型更简单明了、易记）A,TypeI,nondisplaced.无

2、移位B,TypeII,displacedanteriormarginwithanintactposteriorcortexactingasahinge.前部移位张口、后部以骨皮质铰链C,TypeIII,completelydisplacedandvoidofallbonycontact.完全移位，骨质无连接D,TypeIV,comminuted.移位并粉碎治疗措施的选择NonsurgicalManagementTypeI:Thekneeshouldbeimmobilizedinapositionofcomfort.Immobilizationinapproxima

3、tely20°offlexionhasbeenrecommended建议屈曲20°固定Radiographicunionisseenafter6to12weeks,atwhichtimethecastmayberemovedandweightbearingandrange-of-motion(ROM)exercisesinitiated.（6-12周平片可见骨质连接，早期即行支具保护下功能活动锻炼）治疗措施的选择TypeIITypeIIfracturescanbemanagednonsurgicallywhensuccessfulclosedreductionis

4、achieved.闭合复位成功2型亦可非手术治疗治疗措施的选择SurgicalManagementRecentadvancesinarthroscopictechniquehaveledtoatrendofarthroscopicfixationfortypeII,III,andIVtibialeminencefractures.治疗措施的选择国内主流观点关节镜下手术I型保守治疗III型手术治疗基本已成定论对于II型骨折的治疗仍有争议。治疗措施的选择有文献认为骨折后由于半月板前角、半月板间横韧带或碎骨片的阻挡常常使闭合复位较为困难且不稳定。长时间固定，股四头肌萎

5、缩，膝关节内淤血机化，粘连，骨折不愈合，畸形愈合，韧带挛缩变短，保守治疗屈伸功能不能保证关节内骨折应进行解剖复位，保证关节面的平整，防止或延缓创伤性关节炎的发生内固定物的选择丝线钢丝锚钉门型钉可吸收螺钉空心钉门型钉钢丝男性，27岁，右膝关节外伤后肿痛不适三周，摔倒受伤后于当地医院拍片提示“胫骨髁间棘撕脱骨折”，管型石膏固定PCL撕脱骨折术后皮肤切口：膝后正中“Ｓ＂行切口后叉止点撕脱骨折：膝关节后内侧倒L形切口Rehabilitationdependsonthequalityoffixation,patientcompliance,thenatureofthefra

6、cture.RehabilitationTypeIfracturesshouldbeimmobilizedfor2to6weeks,followedbyprotectedROMandweightbearing.（preadolescent）Isometricquadricepsmuscleexercisesshouldbeperformedthroughouttheimmobilizationperiodtominimizedisuseatrophy.Theriskofstiffnessaftersurgicalfixationoftibialeminencefr

7、acturesisgreatlyincreasedcomparedwithnonsurgicalmanagement;thus,earlyROMisrecommendedfollowingsurgicalmanagementImmediateweightbearingandROMmaybeallowedforfracturesthatarerigidlyfixedusingscrews,whereaslongerperiodsofimmobilizationandprotectedweightbearingarepreferredaftersuturefixati

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