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1、脛骨髁間棘撕脫骨折宮月明分型Meyers和McKeever分型III型I型：骨折無(wú)移位或前緣的輕度移位；II型：骨折前方部分移位，后方鉸鏈側(cè)完整，成鳥(niǎo)嘴狀；III型：完全移位，3a僅累及acl止點(diǎn)；3b整個(gè)髁間棘注：Meyers-Mckeever-Zaricznyj分型將3b詳細(xì)敘述，單獨(dú)分出為Ⅳ型。（Ⅳ型：分層碎裂骨折，完全抬起并翻轉(zhuǎn)）Themodifiedclassificationoftibialintercondylareminencefracture.（改良的Meyers–McKeever分型更簡(jiǎn)單明了、易記）A,TypeI,nondisplaced.無(wú)
2、移位B,TypeII,displacedanteriormarginwithanintactposteriorcortexactingasahinge.前部移位張口、后部以骨皮質(zhì)鉸鏈C,TypeIII,completelydisplacedandvoidofallbonycontact.完全移位，骨質(zhì)無(wú)連接D,TypeIV,comminuted.移位并粉碎治療措施的選擇NonsurgicalManagementTypeI:Thekneeshouldbeimmobilizedinapositionofcomfort.Immobilizationinapproxima
3、tely20°offlexionhasbeenrecommended建議屈曲20°固定Radiographicunionisseenafter6to12weeks,atwhichtimethecastmayberemovedandweightbearingandrange-of-motion(ROM)exercisesinitiated.（6-12周平片可見(jiàn)骨質(zhì)連接，早期即行支具保護(hù)下功能活動(dòng)鍛煉）治療措施的選擇TypeIITypeIIfracturescanbemanagednonsurgicallywhensuccessfulclosedreductionis
4、achieved.閉合復(fù)位成功2型亦可非手術(shù)治療治療措施的選擇SurgicalManagementRecentadvancesinarthroscopictechniquehaveledtoatrendofarthroscopicfixationfortypeII,III,andIVtibialeminencefractures.治療措施的選擇國(guó)內(nèi)主流觀點(diǎn)關(guān)節(jié)鏡下手術(shù)I型保守治療III型手術(shù)治療基本已成定論 對(duì)于II型骨折的治療仍有爭(zhēng)議。治療措施的選擇有文獻(xiàn)認(rèn)為骨折后由于半月板前角、半月板間橫韌帶或碎骨片的阻擋常常使閉合復(fù)位較為困難且不穩(wěn)定。長(zhǎng)時(shí)間固定，股四頭肌萎
5、縮，膝關(guān)節(jié)內(nèi)淤血機(jī)化，粘連，骨折不愈合，畸形愈合，韌帶攣縮變短，保守治療屈伸功能不能保證關(guān)節(jié)內(nèi)骨折應(yīng)進(jìn)行解剖復(fù)位，保證關(guān)節(jié)面的平整，防止或延緩創(chuàng)傷性關(guān)節(jié)炎的發(fā)生內(nèi)固定物的選擇絲線鋼絲錨釘門型釘可吸收螺釘空心釘門型釘鋼絲男性，27歲，右膝關(guān)節(jié)外傷后腫痛不適三周，摔倒受傷后于當(dāng)?shù)蒯t(yī)院拍片提示“脛骨髁間棘撕脫骨折”，管型石膏固定PCL撕脫骨折術(shù)后皮膚切口：膝后正中“Ｓ＂行切口后叉止點(diǎn)撕脫骨折：膝關(guān)節(jié)后內(nèi)側(cè)倒L形切口Rehabilitationdependsonthequalityoffixation,patientcompliance,thenatureofthefra
6、cture.RehabilitationTypeIfracturesshouldbeimmobilizedfor2to6weeks,followedbyprotectedROMandweightbearing.（preadolescent）Isometricquadricepsmuscleexercisesshouldbeperformedthroughouttheimmobilizationperiodtominimizedisuseatrophy.Theriskofstiffnessaftersurgicalfixationoftibialeminencefr
7、acturesisgreatlyincreasedcomparedwithnonsurgicalmanagement;thus,earlyROMisrecommendedfollowingsurgicalmanagementImmediateweightbearingandROMmaybeallowedforfracturesthatarerigidlyfixedusingscrews,whereaslongerperiodsofimmobilizationandprotectedweightbearingarepreferredaftersuturefixati
8、on注：大
