,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,胫骨髁间棘撕脱骨折,1,胫骨髁间棘撕脱骨折1,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）,2,分型Meyers和McKeever分型III型2,3,3,4,4,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,5,The modified classification,6,6,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）,7,治疗措施的选择Nonsurgical Management7,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,8,治疗措施的选择Type II8,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.,9,治疗措施的选择Surgical Management9,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。,10,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,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,11,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,内固定物的选择,丝线,钢丝,锚钉,门型钉,可吸收螺钉,12,内固定物的选择丝线12,13,13,14,14,空心钉,15,空心钉15,门型钉,16,门型钉16,钢 丝,17,钢 丝17,18,18,19,19,20,20,21,21,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,22,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,23,23,24,24,25,25,PCL,撕脱骨折,26,PCL撕脱骨折26,27,27,术 后,28,术 后28,皮肤切口：膝后正中“行切口,29,皮肤切口：膝后正中“行切口 29,30,30,后叉止点撕脱骨折：膝关节后内侧倒,L,形切口,31,后叉止点撕脱骨折：膝关节后内侧倒L形切口 31,32,32,Rehabilitation,depends on the quality of fixation,patient compliance,the nature of the fracture.,33,Rehabilitationdepends on the q,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.,34,RehabilitationType I fracture,The risk of stiffness after surgical,fixation of tibial eminence fractures,is greatly increased compared with,nonsurgical management;thus,early,ROM is recommended following,surgical management,35,The risk of stiffness after su,Immediate weight bearing and ROM may be allowed for fractures that are rigidly fixed using screws,whereas longer periods of immobilization and protected weight bearing are preferred after suture fixation,注：大胆的外国人，与全民医疗的环境有关,36,Immediate weight bearing and R,谢谢各位老师！,37,37,