胫骨髁间棘撕脱骨折

.,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，单独分出为型。（型：分层碎裂骨折，完全抬起并翻转）,.,.,.,Themodifiedclassificationoftibialintercondylareminencefracture.（改良的MeyersMcKeever分型更简单明了、易记）A,TypeI,nondisplaced.无移位B,TypeII,displacedanteriormarginwithanintactposteriorcortexactingasahinge.前部移位张口、后部以骨皮质铰链C,TypeIII,completelydisplacedandvoidofallbonycontact.完全移位，骨质无连接D,TypeIV,comminuted.移位并粉碎,.,.,治疗措施的选择,NonsurgicalManagementTypeI:Thekneeshouldbeimmobilizedinapositionofcomfort.Immobilizationinapproximately20offlexionhasbeenrecommended建议屈曲20固定Radiographicunionisseenafter6to12weeks,atwhichtimethecastmayberemovedandweightbearingandrange-of-motion(ROM)exercisesinitiated.（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,TypeIITypeIIfracturescanbemanagednonsurgicallywhensuccessfulclosedreductionisachieved.闭合复位成功2型亦可非手术治疗,.,治疗措施的选择,SurgicalManagementRecentadvancesinarthroscopictechniquehaveledtoatrendofarthroscopicfixationfortypeII,III,andIVtibialeminencefractures.,.,治疗措施的选择,国内主流观点关节镜下手术,I型保守治疗III型手术治疗基本已成定论对于II型骨折的治疗仍有争议。,.,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“行切口,.,.,后叉止点撕脱骨折：膝关节后内侧倒L形切口,.,.,Rehabilitation,dependsonthequalityoffixation,patientcompliance,thenatureofthefracture.,.,Rehabilitation,TypeIfracturesshouldbeimmobilizedfor2to6weeks,followedbyprotectedROMandweightbearing.（preadolescent）Isometricquadricepsmuscleexercisesshouldbeperformedthroughouttheimmobilizationperiodtominimizedisuseatrophy.,.,Theriskofstiffnessaftersurgicalfixationoftibialeminencefracturesisgreatlyincreasedcomparedwithnonsurgicalmanagement;thus,earlyROMisrecommendedfollowingsurgicalmanagement,.,ImmediateweightbearingandROMmaybeallowedforfracturesthatarerigidlyfixedusingscrews,whereaslongerper