脛骨髁間棘撕脫骨折課件

脛骨髁間棘撕脫骨折宮月明分型Meyers和McKeever分型III型I型：骨折無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Ⅳ型。（Ⅳ型：分層碎裂骨折，完全抬起并翻轉(zhuǎn)）

Themodifiedclassificationoftibialintercondylareminencefracture.（改良的Meyers–McKeever分型更簡(jiǎn)單明了、易記）A,TypeI,nondisplaced.無移位

B,TypeII,displacedanteriormarginwithanintactposteriorcortexactingasahinge.前部移位張口、后部以骨皮質(zhì)鉸鏈C,TypeIII,completelydisplacedandvoidofallbonycontact.完全移位，骨質(zhì)無連接D,TypeIV,comminuted.移位并粉碎

治療措施的選擇NonsurgicalManagement

TypeI:Thekneeshouldbeimmobilizedinapositionofcomfort.Immobilizationinapproximately20°offlexionhasbeenrecommended建議屈曲20°固定Radiographicunionisseenafter6to12weeks,atwhichtimethecastmayberemovedandweightbearingandrange-of-motion(ROM)exercisesinitiated.（6-12周平片可見骨質(zhì)連接，早期即行支具保護(hù)下功能活動(dòng)鍛煉）

治療措施的選擇TypeIITypeIIfracturescanbemanagednonsurgicallywhensuccessfulclosedreductionisachieved.閉合復(fù)位成功2型亦可非手術(shù)治療治療措施的選擇國(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。內(nèi)固定物的選擇絲線鋼絲錨釘門型釘可吸收螺釘空心釘門型釘鋼絲PCL撕脫骨折術(shù)后后叉止點(diǎn)撕脫骨折：膝關(guān)節(jié)后內(nèi)側(cè)倒L形切口Rehabilitationdependsonthequalityoffixation,patientcompliance,thenatureofthefracture.RehabilitationTypeIfracturesshouldbeimmobilizedfor2to6weeks,followedbyprotectedROMandweightbearing.（preadolescent）Isometricquadricepsmuscleexercisesshouldbeperformedthroughouttheimmobilizationperiodtominimizedisuseatrophy.Theriskofstiffnessaftersurgicalfixationoftibialeminencefracturesisgreatlyincreasedcomparedwithnonsurgicalmanagement;thus,earlyROMisrecommendedfollowingsurgicalmanagementImmediateweightbearingandROMmaybeallowedforfracturesthatarerigidlyfixedusingscrews,whereaslongerperiodsofimmobilizationandprotectedweight