脛骨髁間棘撕脫骨折課件

1、脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,分型,Meyers和McKeever分型III型 I型：骨折無(wú)移位或前緣的輕度移位； II型：骨折前方部分移位，后方鉸鏈側(cè)完整，成鳥嘴狀； III型：完全移位， 3a 僅累及acl 止點(diǎn) ； 3b 整個(gè)髁間棘 注：Meyers-Mckeever-Zaricznyj分型將3b詳細(xì)敘述，單獨(dú)分出為型。 （型：分層碎裂骨折 ，完全抬起并翻轉(zhuǎn)）,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,The modified classification of tibial intercondylar eminence fracture.

2、 （改良的Meyers McKeever分型更簡(jiǎn)單明了、易記 ） A, Type I, nondisplaced.無(wú)移位 B, Type II, displaced anterior margin with an intact posterior cortex acting as a hinge. 前部移位張口、后部以骨皮質(zhì)鉸鏈 C, Type III,completely displaced and void of all bony contact. 完全移位，骨質(zhì)無(wú)連接 D, Type IV, comminuted.移位并粉碎,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,治療措施的選擇,Non

3、surgical Management Type I :The knee should be immobilized in a position of comfort. Immobilization in approximately 20 of flexion has been recommended建議屈曲20固定 Radiographic union is seen after 6 to 12 weeks, at which time the cast may be removed and weight bearing and range-of-motion (ROM) exercises

4、 initiated.（6-12周平片可見(jiàn)骨質(zhì)連接，早期即行支具保護(hù)下功能活動(dòng)鍛煉）,脛骨髁間棘撕脫骨折,治療措施的選擇,Type II Type II fractures can be managed nonsurgically when successful closed reduction is achieved.閉合復(fù)位成功2型亦可非手術(shù)治療,脛骨髁間棘撕脫骨折,治療措施的選擇,Surgical Management Recent advances in arthroscopic technique have led to a trend of arthroscopic fixatio

5、n for type II, III, and IV tibial eminence fractures.,脛骨髁間棘撕脫骨折,治療措施的選擇,國(guó)內(nèi)主流觀點(diǎn)關(guān)節(jié)鏡下手術(shù),I型保守治療III型手術(shù)治療基本已成定論對(duì)于II型骨折的治療仍有爭(zhēng)議。,脛骨髁間棘撕脫骨折,治療措施的選擇,有文獻(xiàn)認(rèn)為骨折后由于半月板前角、半月板間橫韌帶或碎骨片的阻擋常常使閉合復(fù)位較為困難且不穩(wěn)定。 長(zhǎng)時(shí)間固定，股四頭肌萎縮，膝關(guān)節(jié)內(nèi)淤血機(jī)化，粘連，骨折不愈合，畸形愈合，韌帶攣縮變短 ，保守治療屈伸功能不能保證 關(guān)節(jié)內(nèi)骨折應(yīng)進(jìn)行解剖復(fù)位，保證關(guān)節(jié)面的平整，防止或延緩創(chuàng)傷性關(guān)節(jié)炎的發(fā)生,脛骨髁間棘撕脫骨折,內(nèi)固定物的選擇,絲線

6、 鋼絲 錨釘 門型釘 可吸收螺釘,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,空心釘,脛骨髁間棘撕脫骨折,門型釘,脛骨髁間棘撕脫骨折,鋼 絲,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,男性，27歲，右膝關(guān)節(jié)外傷后腫痛不適三周，摔倒受傷后于當(dāng)?shù)蒯t(yī)院拍片提示“脛骨髁間棘撕脫骨折”，管型石膏固定,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,PCL撕脫骨折,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,術(shù) 后,脛骨髁間棘撕脫骨折,皮膚切口：膝后正中“行切口,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,后

7、叉止點(diǎn)撕脫骨折：膝關(guān)節(jié)后內(nèi)側(cè)倒L形切口,脛骨髁間棘撕脫骨折,脛骨髁間棘撕脫骨折,Rehabilitation,depends on the quality of fixation, patient compliance, the nature of the fracture.,脛骨髁間棘撕脫骨折,Rehabilitation,Type I fractures should be immobilized for 2 to 6 weeks, followed by protected ROM and weight bearing. （preadolescent ） Isometric quadri

8、ceps muscle exercises should be performed throughout the immobilization period to minimize disuse atrophy.,脛骨髁間棘撕脫骨折,The risk of stiffness after surgical fixation of tibial eminence fractures is greatly increased compared with nonsurgical management; thus, early ROM is recommended following surgical management,脛骨髁間棘撕脫骨折,Immediate weight bearing and ROM may be allowed for fractures that are rigidly fixed using screws, whereas longer periods of immobilization and protected