髌骨脱位合并骨软骨骨折的治疗体会
卢宏章;刘震宁;张道俭;李军;叶一林;
摘要(Abstract)：
[目的]髌骨脱位可合并髌骨或股骨外侧髁的骨软骨骨折,本文探讨可吸收钉/棒内固定治疗骨软骨骨折并同时平衡髌骨稳定性的临床效果。[方法]8例髌骨脱位合并骨软骨骨折患者,男3例,女5例,平均年龄22.8岁。骨软骨骨折发生在髌骨下极3例,股骨外侧髁4例,髌骨下极和股骨外侧髁同时骨折1例。手术采用关节镜结合开放手术治疗。骨软骨骨折采用可吸收钉/棒固定。同时髌骨软组织的重建或修复:髌骨内侧支持带折叠缝合+外侧支持带松解3例,内侧髌股韧带修复或重建+外侧支持带松解3例。2例未作处理。术后进行X线评估以及膝关节功能评估。[结果]所有患者骨软骨骨折均愈合,没有髌股关节疼痛和关节交锁。术后髌骨稳定性和膝关节功能恢复良好。[结论]髌骨脱位合并骨软骨骨折者,对骨软骨骨折进行内固定治疗效果良好,可同期重建髌骨稳定性。
关键词(KeyWords)： 髌骨脱位;骨软骨骨折;内固定;膝关节镜
基金项目(Foundation):
作者(Author): 卢宏章;刘震宁;张道俭;李军;叶一林;
Email:
DOI:
参考文献(References)：
- [1]Chotel F,Knorra G,Simianb E,et al.Knee osteochondral fractures in skeletally immature patients:French multicenter study[J].Orthop Traumatol Surg Res,2011,8:154-159.
- [2]Callewier A,Monsaert A,Lamraski G.Lateral femoral condyle osteochondral fracture combined to patellar dislocation:a case report[J].Orthop Traumatol Surg Res,2009,95:85-88.
- [3]Stefancin JJ,Parker RD.First-time traumatic patellar dislocation:a systematic review[J].Clin Orthop,2007,455:93-101.
- [4]Slabaugh MA,Hess DJ,Bajaj S,et al.Management of chondral injuries associated with patellar instability[J].Oper Tech Sports Med,2010,18:115-122.
- [5]Dejour H,Walch G,Nove-Josserand L,et al.Factors of patellar instability:an anatomic radiographic study[J].Knee Surg Sports Traumatol Arthrosc,1994,2:19-26.
- [6]Wouters DB,Burgerhof JGM,de Hosson JTM,et al.Fixation of osteochondral fragments in the human knee using meniscus arrows[J].Knee Surg Sports Traumatol Arthrosc,2011,19:183-188.
- [7]喻长纯,杨明路,王战朝.习惯性髌骨脱位合并髌骨骨软骨骨折的手术治疗[J].中国矫形外科杂志,2006,11:870-871.
- [8]Gkiokas A,Morassi LG,Kohl S,et al.Bioabsorbable pins for treatment of osteochondral fractures of the knee after acute patella dislocation in children and young adolescents[J].Adv Orthop,2012:249687.
- [9]Seeley M,Bowman KF,Walsh C,et al.Magnetic resonance imaging of acute patellar dislocation in children:patterns of injury and risk factors for recurrence[J].J Pediatr Orthop,2012,32:145-155.
- [10]Balcarek P,Ammon J,Frosch S,et al.Magnetic resonance imaging characteristics of the medial patellofemoral ligament lesion in acute lateral patellar dislocations considering trochlear dysplasia,patella alta,and tibial tuberosity-trochlear groove distance[J].Arthroscopy,2010,26:926-935.