胫骨髁间棘撕脱骨折.ppt

胫骨髁间棘撕脱骨折 宫月明 分型 Meyers和McKeever分型III型 I型：骨折无移位或前缘的轻度移位； II型：骨折前方部分移位，后方铰链侧完整，成鸟嘴状； III型：完全移位， 3a 仅累及acl 止点 ； 3b 整个髁间棘 注：Meyers-Mckeever-Zaricznyj分型将3b详细叙述，单独分出为Ⅳ型。 （Ⅳ型：分层碎裂骨折 ，完全抬起并翻转） The modified classification of tibial intercondylar eminence fracture. （改良的Meyers – McKeever分型更简单明了、易记 ） A, Type I, nondisplaced.无移位 B, Type II, displaced anterior margin with an intact posterior cortex acting as a hinge. 前部移位张口、后部以骨皮质铰链 C, Type III,completely displaced and void of all bony contact. 完全移位，骨质无连接 D, Type IV, comminuted.移位并粉碎 治疗措施的选择 Nonsurgical Management Type I :The knee should be immobilized in a position of comfort. Immobilization in approximately 20° of flexion has been recommended建议屈曲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周平片可见骨质连接，早期即行支具保护下功能活动锻炼） 治疗措施的选择 Type II Type II fractures can be managed nonsurgically when successful closed reduction is achieved.闭合复位成功2型亦可非手术治疗 治疗措施的选择 Surgical Management Recent advances in arthroscopic technique have led to a trend of arthroscopic fixation for type II, III, and IV tibial eminence fractures. 治疗措施的选择 国内主流观点关节镜下手术 治疗措施的选择 有文献认为骨折后由于半月板前角、半月板间横韧带或碎骨片的阻挡常常使闭合复位较为困难且不稳定。 长时间固定，股四头肌萎缩，膝关节内淤血机化，粘连，骨折不愈合，畸形愈合，韧带挛缩变短 ，保守治疗屈伸功能不能保证 关节内骨折应进行解剖复位，保证关节面的平整，防止或延缓创伤性关节炎的发生 内固定物的选择 丝线 钢丝 锚钉 门型钉 可吸收螺钉 空心钉 门型钉 钢 丝 男性，27岁，右膝关节外伤后肿痛不适三周，摔倒受伤后于当地医院拍片提示“胫骨髁间棘撕脱骨折”，管型石膏固定 PCL撕脱骨折 术 后 皮肤切口：膝后正中“Ｓ＂行切口 后叉止点撕脱骨折：膝关节后内侧倒L形切口 Rehabilitation depends on the quality of fixation, patient compliance, the nature of the fracture. Rehabilitation Type 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 immobilization period to minimize disuse atrophy. The risk of stiffness after surgical fixation of tibial eminence fractures is greatly in