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詳細敘述，單獨分出為Ⅳ型。（Ⅳ型：分層碎裂骨折，完全抬起并翻轉）

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

B,TypeII,displacedanteriormarginwithanintactposteriorcortexactingasahinge.前部移位張口、后部以骨皮質鉸鏈C,TypeIII,completelydisplacedandvoidofallbonycontact.完全移位，骨質無連接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周平片可見骨質連接，早期即行支具保護下功能活動鍛煉）

治療措施的選擇TypeIITypeIIfracturescanbemanagednonsurgicallywhensuccessfulclosedreductionisachieved.閉合復位成功2型亦可非手術治療治療措施的選擇國內主流觀點關節(jié)鏡下手術

I型保守治療III型手術治療基本已成定論

對于II型骨折的治療仍有爭議。內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撕脫骨折術后后叉止點撕脫骨折：膝關節(jié)后內側倒L形切口Rehabilitationdependsonthequalityoffixation,patientcompliance,thenatureofthefracture.RehabilitationTypeIfracturesshouldbeimmobilizedfor2to6weeks,followedbyprotectedROMandweightbearing.（preadolescent）Isometricquadricepsmuscleexercisesshouldbeperformedthroughouttheimmobilizationperiodtominimizedisuseatrophy.Theriskofstiffnessaftersurgicalfixationoftibialeminencefracturesisgreatlyincreasedcomparedwithnonsurgicalmanagement;thus,earlyROMisrecommendedfollowingsurgicalmanagementImmediateweightbearingandROMmaybeallowedforfracturesthatarerigidlyfixedusingscrews,whereaslongerperiodsofimmobilizationandprotectedweight