胫骨髁间棘撕脱骨折分型n nMeyersMeyers和和McKeeverMcKeever分型分型IIIIII型型n nI I型：骨折无移位或前缘的轻度移位；型：骨折无移位或前缘的轻度移位；n nIIII型：骨折前方部分移位，后方铰链侧完整，成型：骨折前方部分移位，后方铰链侧完整，成鸟嘴状；鸟嘴状；n nIIIIII型：完全移位，型：完全移位，n n 3a 3a 仅累及仅累及acl acl 止点止点 ；n n 3b 3b 整个髁间棘整个髁间棘n n注：注：Meyers-Mckeever-ZaricznyjMeyers-Mckeever-Zaricznyj分型将分型将3b3b详详细叙述，单独分出为细叙述，单独分出为型。型。 （型：分层碎裂骨折型：分层碎裂骨折 ，完全抬起并翻转），完全抬起并翻转） n nThe modified classification of tibial The modified classification of tibial intercondylar eminence fracture. intercondylar eminence fracture. （改良的（改良的Meyers McKeeverMeyers McKeever分型更简单明了、易记分型更简单明了、易记 ）n nA, A, Type I, nondisplaced.Type I, nondisplaced.无移位无移位 B, B, Type II, displaced anterior margin with Type II, displaced anterior margin with an intact posterior cortex acting as a an intact posterior cortex acting as a hinge. hinge. 前部移位张口、后部以骨皮质铰链前部移位张口、后部以骨皮质铰链 C, C, Type III,completely displaced and void Type III,completely displaced and void of all bony contact. of all bony contact. 完全移位，骨质无连接完全移位，骨质无连接 D, D, Type IV, comminuted.Type IV, comminuted.移位并粉碎移位并粉碎 治疗措施的选择n nNonsurgical ManagementNonsurgical Management T Type Iype I :The knee should be immobilized in a :The knee should be immobilized in a position of comfort. Immobilization in position of comfort. Immobilization in approximately 20 of flexion has been approximately 20 of flexion has been recommendedrecommended建议屈曲建议屈曲2020固定固定n nRadiographic union is seen after 6 to 12 weeks, Radiographic union is seen after 6 to 12 weeks, at which time the cast may be removed and at which time the cast may be removed and weight bearing and range-of-motion (ROM) weight bearing and range-of-motion (ROM) exercises initiated.exercises initiated.（6-126-12周平片可见骨质连接，早期周平片可见骨质连接，早期即行支具保护下功能活动锻炼）即行支具保护下功能活动锻炼） 治疗措施的选择n nType II Type II fractures can be managednonsurgically when successful closedreduction is achieved.闭合复位成功2型亦可非手术治疗治疗措施的选择n nSurgical 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n n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n n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。n n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 n n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n n丝线n n钢丝n n锚钉 n n门型钉n n可吸收螺钉 空心钉门型钉钢 丝男性，男性，2727岁，右膝关节外伤后肿痛不适三周，摔倒岁，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受伤后于当地医院拍片提示“ “胫骨髁间棘撕脱骨折胫骨髁间棘撕脱骨折” ”，管型石膏固定，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 Rehabilitationn ndepends on the quality of fixation, n npatient compliance,n nthe nature of the fracture. Rehabilitationn nType I fractures should be immobilized for 2 to 6 weeks, followed by protected ROM and weight bearing. （preadolescent ）n nIsometric quadriceps muscle exercises should be performed throughout the immobilization period to minimize disuse atrophy.n nThe risk of stiffness after surgicalfixation of tibial eminence fracturesis greatly increased compared withnonsurgical management; thus, earlyROM is recommended followingsurgical managementn nImmediate 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 谢谢各位老师！谢谢各位老师！