脛骨髁間棘撕脫骨折

脛骨髁間棘撕脫骨折宮月明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詳細敘述，單獨分出為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

NonsurgicalManagementTypeI

: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(shù)治療治療措施的選擇SurgicalManagementRecentadvancesinarthroscopictechniquehaveledtoatrendofarthroscopicfixationfortypeII,III,andIVtibialeminencefractures.12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型骨折的治療仍有爭議。壹貳治療措施的選擇01有文獻認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位較為困難且不穩(wěn)定。02長時間固定，股四頭肌萎縮，膝關(guān)節(jié)內(nèi)淤血機化，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03關(guān)節(jié)內(nèi)骨折應進行解剖復位，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)固定物的選擇門型釘可吸收螺釘絲線鋼絲錨釘Rehabilitationdependsonthequalityoffixation,patientcompliance,thenatureofthefracture.030102RehabilitationTypeIfracturesshouldbeimmobilizedfor2to6weeks,followedbyprotectedROMandweightbearing.（preadolescent）Isometricquadricepsmuscleexercisesshouldbeperformedthroughouttheimmobilizationperiodtominimizedisuseatrophy.1201Theriskofstiffnessaftersurgicalfixationoftibialeminencefracturesisgreatlyincreasedcomparedwith020304nonsurgicalmanagement;thus,earlyROMisrecommendedfollowingsurgicalmanagement0506ImmediateweightbearingandROMmaybeallowedforfracturesthatarerigidlyfixedusingscrews,whereaslongerperio