儿童胫骨近端及骨干骨折

14-year-old boy
The second affiliated hospital of Inner mongolia medical university
胫骨结节骨骺骨折
切开复位 空心螺钉固定 铆钉修复断裂髌腱
The second affiliated hospital of Inner mongolia medical university
胫骨髁间棘骨折
关节镜技术
止血带下进行 清除骨折块下及内陷窝里一切防碍复位的因素 顺行性螺钉或可吸收螺钉固定 石膏固定6周
The second affiliated hospital of Inner mongolia medical university
胫骨髁间棘骨折
正文框
图片框
The second affiliated hospital of Inner mongolia medical university
胫骨近端骺板骨折
机制
通常发生于年长儿童 跳跃性运动多见
The second affiliated hospital of Inner mongolia medical university
胫骨近端骺板骨折
相对少见，源于附着在骺板近端的韧带少 股骨远端/胫骨近端：8:1
可引起腘动脉损伤
The second affiliated hospital of Inner mongolia medical university
胫骨髁间棘骨折 Meyers & McKeever分型
IV
Type Ⅰ：无/轻度移位 Type Ⅱ：部分移位，前方上翘，存在软骨铰链 Type Ⅲ：完全移位 Type IV：翻转
Meyers MH and McKeever FM. Fracture of the intercondylar eminence of th
胫骨结节骨骺骨折
The second affiliated hospital of Inner mongolia medical university
胫骨结节骨骺骨折
术前仔细的体格检查 MRI评估 合并髌腱断裂较为罕见
警惕！
The second affiliated hospital of Inner mongolia medical university
胫骨近端骺板骨折
I、II型：可闭合复位； III、IV型：多数切开复位；
＞7-10d I、II型：不建议再行复位 III、IV型：切开复位；
I II III IV Ⅴ
平行骺板或干骺端固定
The second affiliated hospital of Inner mongolia medical university
胫骨近端干骺端骨折
The second affiliated hospital of Inner mongolia medical university
胫骨近端干骺端骨折
大部分需要保守治疗 手术治疗指证
✓ 开放性骨折 ✓ 折端软组织嵌入 ✓ 合并骨筋膜室综合症
The second affiliated hospital of Inner mongolia medical university
The second affiliated hospital of Inner mongolia medical university
The second affiliated hospital of Inner mongolia medical university
胫骨髁间棘骨折
手术指征
Ⅱ/ Ⅲ不能完全复位或有半月板\半月板韧带嵌入影响复位。 Ⅳ型骨折
血液供应
胫骨近端
胫骨干
Type B
胫后动脉
百度文库
骨骺分离不易发生坏死
下1/3灌注少
The second affiliated hospital of Inner mongolia medical university
生长发育
近端60%
远端40%
The second affiliated hospital of Inner mongolia medical university
诊断
病史 外伤史 体征 体格检查 影象学 X线
CT MRI
The second affiliated hospital of Inner mongolia medical university
内容
胫骨髁间棘骨折 胫骨远端骺板骨折 胫骨结节骨骺骨折 胫骨近端干骺端骨折 胫骨干骨折
The second affiliated hospital of Inner mongolia medical university
螺钉固定 石膏固定6周
The second affiliated hospital of Inner 愈mo合ngo后lia早me期dic取al u出niv！ersity
MRI的重要性
7-year-old boy The second affiliated hospital of Inner mongolia medical university
胫骨结节骨骺骨折
机制
胫骨近端骨骺开始闭
合于青春期晚期
屈曲---撕脱伤
打篮球尝试跳跃投篮
The second affiliated hospital of Inner mongolia medical university
胫骨结节骨骺骨折
IA 型:胫骨和胫骨结节的骨化中心远端，
未完全分离；保守。
胫骨髁间棘骨折
切开复位
髌旁内侧显露 确定半月板完整性 清除积血 钢丝、可吸收线或
螺钉固定 石膏固定6周
The second affiliated hospital of Inner mongolia medical university
胫骨髁间棘骨折
切开复位
髌旁内侧显露 确定半月板完整性 清除积血 钢丝、可吸收线或
Fractures of the shaft and proximal tibia in the Pediatric Patient
儿童胫骨近端及骨干骨折
刘万林
韦宜山 白锐 李岱鹤 赵振群 王勇 孙超 孙亮
内蒙古医科大学第二附属医院 小儿骨科
Pediatric orthopedics, the second affiliated hospital of Inner mongolia medical university
机械轴-解剖轴-下肢机械轴
解剖轴 机械轴 MPTA=87° 正常下肢机械轴线：膝关节中心点内侧8±7mm
治疗目的
The second affiliated hospital of Inner mongolia medical university
诊断
病史 外伤史 体征 体格检查 影象学 X线
The second affiliated hospital of Inner mongolia medical university
胫骨髁间棘骨折
切开复位
髌旁内侧显露 确定半月板完整性 清除积血 钢丝、可吸收线或
螺钉固定 石膏固定6周
The second affiliated hospital of Inner mongolia medical university
胫骨近端骺板骨折
The second affiliated hospital of Inner mongolia medical university
13-year-old girl
S-H Ⅴ
骺板周围水肿
George C. Balazs, Elizabeth M. Polfer, and Jefferson W. Jex. Bilateral crush injury of the proximal tibial physis in an adolescent gymnast. J BTohneesJeocionntdSuarfgfilAiamte. dChaossepCitaolnonfecItnAnperiml -oJnugnoel2ia01m5evdoicl.a5l unnoi.v2eres5it0y.
IB 型:从干骺端完全分离；保守/手术。
IIA型:累及二级骨化中心和胫骨近端骨骺；手术。
IIB型:与ⅡA相同，合并有骨碎块；手术。
ⅢA型:骨折向近端和后侧经过骺板而累及
胫骨近端关节面；手术。
ⅢB型:与ⅢA相同，合并有骨碎块；手术。
Ogden分型
The second affiliated hospital of Inner mongolia medical university
25%
15%
ten-month follow-up
George C. Balazs, Elizabeth M. Polfer, and Jefferson W. Jex. Bilateral crush injury of the proximal tibial physis in an adolescent gymnast. J BTohneesJeocionntdSuarfgfilAiamte. dChaossepCitaolnonfecItnAnperiml -oJnugnoel2ia01m5evdoicl.a5l unnoi.v2eres5it0y.
胫骨近端干骺端骨折
有引起血管损伤的可能，潜在骨筋膜室综合症。
3-8岁儿童，即使在“允许”范围的移位成角，晚期易出
现胫外翻畸形，原因未完全明确。
The second affiliated hospital of Inner mongolia medical university
5-year-old boy
two-month follow-up
George C. Balazs, Elizabeth M. Polfer, and Jefferson W. Jex. Bilateral crush injury of the proximal tibial physis in an adolescent gymnast. J BTohneesJeocionntdSuarfgfilAiamte. dChaossepCitaolnonfecItnAnperiml -oJnugnoel2ia01m5evdoicl.a5l unnoi.v2eres5it0y.
胫骨近端骺板骨折
The second affiliated hospital of Inner mongolia medical university
胫骨近端骺板骨折
The second affiliated hospital of Inner mongolia medical university
CT MRI
The second affiliated hospital of Inner mongolia medical university
诊断
病史 外伤史 体征 体格检查 影象学 X线
CT MRI
The second affiliated hospital of Inner mongolia medical university
3months，6°
6months，8°
14years
The second affiliated hospital of Inner mongolia medical university
胫骨近端解剖
骨骺 骺板 干骺端 骨骺复合体
The second affiliated hospital of Inner mongolia medical university
胫骨近端解剖
X线 解剖 切片
The second affiliated hospital of Inner mongolia medical university
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胫骨髁间棘骨折
保守治疗
Ⅰ/Ⅱ型骨折，膝关节完全伸直位,长腿石膏。 Ⅲ型骨折，试行膝关节完全伸直位复位，长腿石膏。 抽出关节积血。