胫骨髁间棘撕脱骨折课件.ppt

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 increased compared with nonsurgical management; thus, early ROM is recommended following surgical management 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 谢谢各位老师！ 胫骨髁间棘撕脱骨折 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 arthroscop