青少年急性髌骨脱位合并骨软骨骨折的治疗  

Treatment for acute patella dislocation complicated wtih osteochondral fracture in adolescent

作　　者：赵洪波[1] 周宏艳[1] 陈德生[1] 张庆恩[1] 郭岩[1] 张艳蕊[1] 孙健[1] 

机构地区：[1]河北省唐山市第二医院关节科,006300

出　　处：《中华小儿外科杂志》2014年第1期20-23,共4页Chinese Journal of Pediatric Surgery

基　　金：河北省卫生厅2011年医学科学研究重点课题计划（20110624）

摘　　要：目的对青少年急性髌骨脱位同时合并髌骨骨软骨骨折患儿的临床治疗结果进行分析，并回顾以往文献报告，总结该病的治疗体会。方法回顾性分析2005年至2012年间收治的39例急性髌骨脱位合并骨软骨骨折的青少年患儿，男14例，女25例，年龄12～16岁，平均年龄14．9岁，左侧22例，右侧17例，均为运动中髌骨一过性脱位受伤的闭合骨折，所有患儿均手术治疗，可吸收钉固定8例，PDS缝线固定5例，可吸收钉加PDS缝线固定19例，骨折块粉碎、压缩、无法固定而骨折块摘除7例，所有患儿均行髌外侧支持带松解联合内侧支持带紧缩缝合术。随访骨折愈合及关节功能情况。结果34例患儿获得随访，5例失随访，随访时间9～48个月，平均26．5个月，关节活动度恢复正常范围，无明显疼痛症状及髌骨二次脱位发生。结论髌骨骨软骨骨折好发于青少年，应早期明确诊断、及时治疗，根据骨折块大小、位置及是否连同软骨下骨，行复位内固定术或骨块摘除，针对发病机制，同时应积极治疗髌骨不稳，髌外侧支持带松解联合内侧支持带紧缩术简单有效，对纠正髌骨轨迹，降低髌骨再脱位概率有确切临床意义。Objective To analyze the clinical outcome of acute patella dislocation complicated with osteochondral fracture in adolescents, and to review literature concerning the treatment and prognosis of the fracture. Methods From 20（15 to 2012, 39 patients （male 14, female 25） with an average age of 14. 9 years （range, 12-16） who suffered from osteochondral fracture of patella underwent surgery, including 8 cases fixed with absorbable screws, 5 cases fixed with PDS, 19 cases fixed with absorbable screws and PDS simultaneously, and 7 cases with bone block extirpation. All cases suffering patellar dislocation underwent medial patellar retinaculum. Results Thirty-four patients were followed-up （ranged from 9 to 48 months with an average of 26. 5 months）. All cases achieved normal range-of-motion of the joint without obvious pain and redislocation of the patella. Conclusions Osteochondral fracture of patella has a predilection for adolescents, which should be diagnosed in time and treated promptly to lessen secondary injury, Patients with patella dislocation should undergo medial patella retinaculum simulataneously to reduce the incidence of redislocation of patella.

关 键 词：髌骨脱位 骨软骨骨折 可吸收性植入物 

分 类 号：R726.8[医药卫生—儿科]