脛骨髁間棘撕脫骨折

1、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 ； 3b 整個髁間棘注：Meyers-Mckeever-Zaricznyj分型將3b詳細(xì)敘述，單獨分出為型。 （型：分層碎裂骨折 ，完全抬起并翻轉(zhuǎn)） The modified classification of tibial intercondylar eminence fracture. （改良的Meyers McKeever分型更簡單明了、易記 ）A, Type I, nondisplac

2、ed.無移位 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)無連接 D, Type IV, comminuted.移位并粉碎 治療措施的選擇Nonsurgical Management Type I :The knee should be immobilized in a position of

3、 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 initiated.（6-12周平片可見骨質(zhì)連接，早期即行支具保護(hù)下功能活動鍛煉） 治療措施的選擇Type II Type II fractures

4、can be managednonsurgically when successful closedreduction is achieved.閉合復(fù)位成功2型亦可非手術(shù)治療治療措施的選擇Surgical Management Recent advances in arthroscopic technique have led to a trend of arthroscopic fixation for type II, III, and IV tibial eminence fractures.治療措施的選擇國內(nèi)主流觀點關(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于II型骨折的

5、治療仍有爭議。 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。長時間固定，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 PCL撕脫骨折術(shù) 后皮膚切口：膝后正中“行切口 后叉止點撕脫骨折：膝關(guān)節(jié)后內(nèi)側(cè)倒L形切口 Rehabilitationd

6、epends on the quality of fixation, patient compliance,the nature of the fracture. RehabilitationType I fractures should be immobilized for 2 to 6 weeks, followed by protected ROM and weight bearing. （preadolescent ）Isometric quadriceps muscle exercises should be performed throughout the immobilizati

7、on period to minimize disuse atrophy.The risk of stiffness after surgicalfixation of tibial eminence fracturesis greatly increased compared withnonsurgical management; thus, earlyROM is recommended followingsurgical managementImmediate weight bearing and ROM may be allowed for fractures that are rigidly fixed using screws, whereas longer perio