关节镜辅助早期手术治疗创伤性髌骨脱位

目的探讨利用膝关节镜技术辅助治疗创伤性髌骨脱位的手术方法并评估其治疗效果。方法选择2009年10月至2012年10月沈阳军区总医院应用关节镜治疗创伤性髌骨脱位的26例患者为研究对象。其中,男性10例,女性16例;复发性髌骨脱位22例。术前行X线、三维CT及MR等影像学检查,评估髌股关节形态学变异及损伤情况。先行膝关节镜检查,处理关节内合并损伤,清除关节内积血、游离的软骨及骨碎片,镜下可以清楚观察髌内侧及髌骨下极骨软骨损伤及内侧支持带损伤情况,同时处理并存的半月板等关节内结构损伤。于镜下行髌外侧支持带松解完成关节镜操作,辅助小切口修复内侧支持带复合体稳定结构。结果平均随访24.2个月,术后均未出现髌骨再次脱位,膝关节屈伸膝活动度无明显受限,膝关节Lysholm评分优良,无髌骨弹响及不稳感,6~8周恢复日常生活及工作。结论关节镜辅助治疗创伤性髌骨脱位,安全可靠,值得推广。     

急性髌骨外侧脱位的MRI分析

目的 结合损伤机制探讨急性髌骨外侧脱位的MRI特征表现.资料与方法 回顾性分析42例急性髌骨外侧脱位患者的MRI资料,由两名放射科医师共同确定骨髓水肿、骨软骨骨折、髌骨位置、髌骨内侧支持带的损伤、关节积液及其他合并损伤情况.结果 (1)股骨外髁前侧面和髌骨内下关节面骨髓水肿的出现率均为98%(41/42),其中95%(40/42)两处同时出现.其余区域骨髓水肿的出现率仅为7%(3/42).(2)36%(15/42)可见髌骨内后缘骨软骨骨折,10%(4/42)出现股骨外髁骨软骨骨折,其余区域则无.(3)2%(1/42)髌骨仍处于脱位状态,50%(21/42)髌骨呈半脱位,其余48%(20/42)髌骨位置正常.(4)62%(26/42)可见髌骨内侧支持带异常,43%(18/42)合并股内侧斜肌损伤,37%(16/42)合并股外侧肌水肿,7%(3/42)出现髌骨外侧支持带异常,2%(1/42)合并内侧副韧带损伤.(5)100%(42/42)出现关节积液,包括关节积血5例、关节脂血症2例.结论 急性髌骨外侧脱位的MRI表现取决于其特定的损伤机制,股骨外髁前侧面和髌骨内下关节面同时出现的骨髓水肿、髌骨内后缘的骨软骨骨折、髌骨内侧支持带异常、股内侧斜肌和股外侧肌的损伤为常见而又具有特征的MRI征象.     

儿童急性外侧髌骨脱位后内侧髌股韧带损伤模式:与髌骨解剖变异及关节软骨病变的关系

正摘要目的评估儿童急性外侧髌骨脱位后内侧髌股韧带损伤模式及其与髌骨解剖变异及关节软骨病变的关系。方法获取140例急性髌骨外侧脱位儿童的MR影像,采用标准化模式获取和评估影像。结果 58例病人内侧髌股韧带部分断裂,75例完全断裂。52例损伤发生在单纯髌骨插入处(PAT),42例损伤发生在单纯股骨附着处(FEM),5例发生在单纯中部(MID)。34例损伤多于1处。与Wiberg C型髌骨比较,Wiberg B型髌骨内侧髌股韧带更易发生完全断裂(P=0.042)。内侧髌股韧带损伤模式与滑车发育不良、髌骨高度     

髌骨内侧支持带稳定机制的研究

目的 :研究髌骨内侧支持带的解剖学特点及其在髌骨稳定中的作用。方法 :在 13具成人尸体 2 6例膝关节标本上 ,解剖观察髌骨内侧支持带的组成 ,以及各组成部分在髌骨稳定中的作用。结果 :髌骨内侧支持带由髌股内侧韧带、髌胫内侧韧带和髌骨半月板韧带等三部分组成 ,其中以髌股内侧韧带最厚 ,并在对抗髌骨向外侧移位中起主要作用     

髌股关节紊乱的MRI表现与临床

目的：探讨髌股关节紊乱(PFD)的MRI表现。方法：膝关节正常组6例(10个膝)及病例组42例(70个膝)受试者均行MRI检查,对病理性髌股关系及髌骨支持带的表现进行分析。结果：所有病例(70个膝)髌骨外侧半脱位程度6～15 mm,60％为双侧。其他恒定的异常包括股骨滑车发育不良、髌骨内侧支持带薄、髌外侧支持带增厚以及...     

髂胫束重建内侧髌股韧带治疗习惯性髌骨脱位

目的:探讨采用髂胫束重建内侧髌股韧带治疗习惯性髌骨脱位的手术方法和临床效果。方法:2006年9月至2009年2月,对12例习惯性髌骨脱位患者的13个膝关节进行了手术治疗,男4例,女8例,平均年龄27岁。全部病例行髌骨外侧软组织松解,内侧关节囊紧缩,取带Gerdy’s结节骨块的髂胫束组织重建内侧髌股韧带。结果:全部患者均得到随访,随访时间1～3年,平均23个月。1例双膝手术者脱位复发,余11例无髌骨再脱位。2例患者膝关节屈曲略受限。5例感膝关节无力。结论:髌骨外侧软组织松解,内侧关节囊紧缩,髂胫束重建内侧髌股韧带治疗习惯性髌骨脱位,操作简单,效果可靠,手术损伤小,恢复快。     

内侧髌骨股骨韧带重建手术技术

复发性髌骨脱位是临床常见疾病[1]。以往的治疗方法包括髌骨外侧支持带松解[2-5]、髌骨内侧支持带紧缩重叠缝合[3,6]、胫骨结节内移截骨[7]、股内侧肌止点移位术[8]等。近来,内侧髌股韧带(medial patellofemoral ligament,MPFL)重建对于治疗复发性髌骨脱位取得良好的临床效果[9     

改良Hauser术后髌股关节软骨的变化

目的:通过再次关节镜检查,了解改良Hauser手术后髌股关节软骨的变化。方法:2004年4月至2008年7月,36例髌骨脱位患者在我所进行了改良Hauser髌骨脱位矫正术,并因取金属内固定物进行了二次关节镜检查。分别评估两次关节镜检查时髌骨内侧、外侧,滑车内侧与外侧的软骨损伤情况。结果:(1)36例患者初次手术时共发现52处软骨损伤,再次关节镜检查时共发现78处软骨损伤。(2)初次及再次手术时的软骨损伤程度以2～3度为主,再次手术时增加的软骨损伤绝大部分为2度,占所有增加软骨损伤的90%。(3)初次手术时有32处髌骨软骨损伤,其中30处位于髌骨内侧,2处位于髌骨外侧面,有20处滑车软骨损伤,都位于滑车外侧面。再次手术时有28处位于髌骨内侧,16处位于髌骨外侧,14处位于滑车内侧,20处位于滑车外侧。再次手术时髌骨内侧与滑车外侧软骨损伤无明显增加,髌骨外侧及滑车内侧的软骨损伤有明显增加。结论:改良Hauser手术后髌股关节软骨损伤有一定增加,以滑车内侧及髌骨外侧的软骨损伤增加为主,增加的软骨损伤多为2度。     

关节镜下内侧髌股韧带重建和外侧支持带松解治疗复发性髌骨脱位的疗效分析

目的分析关节镜下内侧髌股韧带(MPFL)重建和外侧支持带松解治疗复发性髌骨脱位疗效。方法选取2019年1月1日-12月31日收治的50例复发性髌骨脱位患者,随机分为研究组、对照组,研究组行关节镜下MPFL重建和外侧支持带松解术,对照组行常规MPFL重建和外侧支持带松解术,对比两组手术效果。结果治疗后,研究组Lysholm、Kujala评分明显高于对照组,且VAS评分、股骨和谐角、股骨滑车角明显更低,差异具有统计学意义(P<0.05)。结论对复发性髌骨脱位患者给予关节镜下MPFL重建和外侧支持带松解术治疗术野清晰,可尽快恢复髌骨生理结构及功能,减轻患者疼痛感。     

急性滑脱性髌股关节撞击综合征的3.0T MRI诊断

【摘要】目的：探讨急性滑脱性髌股关节撞击综合征的MRI特点及损伤机制。方法：从1782例急性膝关节外伤的MRI资料中筛选出28例经临床MRI诊断急性滑脱性髌股关节撞击综合征的患者,分析其膝关节的MRI表现。结果：28例急性滑脱性髌股关节撞击综合征中,髌骨骨挫伤28例,损伤部位位于髌骨内侧缘皮质下,部分挫伤范围延伸至髌骨嵴。股骨外侧髁挫伤21例,损伤部位位于股骨外侧髁前、中部或前外缘皮质下,部分延伸至外侧髁后部、髁间窝。髌骨内侧缘软骨损伤16例。股骨外侧髁前外侧缘软骨损伤13例。内侧支持带损伤28例,其中I级损伤10例,Ⅱ级损伤13例,Ⅲ级损伤5例。7例外侧支持带损伤,其中I级损伤5例,Ⅱ级损伤2例,未见Ⅲ级损伤。髌骨位置正常19例,向外半脱位5例,完全性脱位4例。关节腔内游离体8例。28例关节积液,其中9例血性积液。结论：MRI能全面显示急性滑脱性髌股关节撞击综合征的损伤机制,为术前诊断及临床治疗提供帮助。     

High resolution magnetic resonance imaging of the patellar retinaculum: normal anatomy, common injury patterns, and pathologies

The medial patellar retinaculum (MPR) and the lateral patellar retinaculum (LPR) are vital structures for the stability of the patella. Failure to identify or treat injury to the patellar retinaculum is associated with recurrent patellar instability and contributes to significant morbidity. High-resolution magnetic resonance imaging (MRI) readily depicts the detailed anatomy of various components (layers) of the retinacula. In this review article, we discuss normal anatomy, important landmarks, common injury patterns, and other pathologies encountered in patellar retinacula. High field strength MRI is an excellent noninvasive tool for evaluation of patellar retinaculum anatomy and pathology. This article will help the reader become familiar with normal imaging findings and the most commonly occurring injuries/pathologies in MPR and LPR.     

Transient lateral patellar dislocation: review of imaging findings, patellofemoral anatomy, and treatment options

Transient patellar dislocation is a common sports-related injury in young adults. Although patients often present to the emergency department with acute knee pain and hemarthrosis, spontaneous reduction frequently occurs, and half of cases are unsuspected clinically. Characteristic magnetic resonance imaging (MRI) findings often lead to the diagnosis. The purpose of this review is to illustrate the MRI findings of lateral patellar dislocation and concomitant injuries, such as kissing contusions of the medial patella and lateral femoral condyle; osteochondral and avulsion fractures; and injuries of the medial patellofemoral ligament/retinacular complex. This article will also briefly review patellofemoral anatomy and passive, active, and static stabilizers. Predisposing factors for patellar instability, including trochlear dysplasia, patella alta, and lateralization of the patella or tibial tuberosity and their relevant measurements will also be highlighted. Treatment options, including surgery, such as medial patellofemoral ligament reconstruction, tibial tuberosity transfer, and trochleoplasty, and their postoperative imaging appearances will also be discussed.     

膝关节Ⅴ型骨挫伤的MRI诊断及临床意义

目的 评价MRI对膝关节Ⅴ型骨挫伤的诊断价值及临床意义.方法 从1672例急性膝关节外伤的MRI资料中筛选出具有Ⅴ型骨挫伤的患者,分析其膝关节MRI表现.结果 Ⅴ型骨挫伤发生率2.6%(43/1672),表现为同时累及髌骨内下缘及股骨外髁前外缘的异常信号,在T_1WI上表现为低信号,在T_2WI上表现为等或稍高信号,在压脂PDWI上为高信号,在矢状面、冠状面及横断面上均可以敏感发现.MRI上显示骨折9例,软骨损伤29例,髌骨向外半脱位或脱位27例.髌骨内侧支持带损伤37例,在横断面上显示最佳并能进行分级.结论 MRI能准确显示膝关节Ⅴ型骨挫伤,对髌骨一过性脱位的诊断和治疗有重要意义.在MR检查中发现Ⅴ型骨挫伤时应加作髌骨横断面检查,以评估髌骨内侧支持带的损伤情况.     

The case for advancement and repairof the medial patellofemoral ligament in patients with recurrent patellar instability

In much of the literature about patellar instability, the role of the passive medial patellar stabilizers traditionally has been ignored or afforded only passing comment. But excessive passive lateral patellar mobility must be considered an essential element in the majority of patients with recurrent acute lateral patellar instability. In patients who have sustained patellar dislocation, numerous authors have shown excessive lateral or total mediolateral patellar mobility compared with normal controls. Clinical and laboratory magnetic resonance evidence suggests that the medial retinaculum shows typical patterns of injury in many cases of acute lateral patellar dislocation. Residual laxity of these soft tissue restraints can be sufficient to allow recurrent lateral instability of the patella after the initial dislocation event. Several studies suggest that the medial patellofemoral ligament (MPFL) is the primary passive soft tissue restraint to lateral patellar displacement. These studies have shown promising evidence that repair and/or advancement of the MPFL is capable of restoring normal lateral patellar mobility in cadaver specimens. If the MPFL is repaired effectively in patients who have sustained retinacular injury in the setting of patellar dislocation, then it should reduce the risk of recurrent patellar instability. In this article, the senior author's surgical technique for advancement and repair of the MPFL is presented. Postoperative rehabilitation is also discussed.     

关节镜辅助下修复内侧髌股韧带治疗创伤性髌骨不稳

目的:探讨关节镜辅助下内侧髌股韧带(MPFL)修复术在治疗创伤性髌骨脱位中的效果。方法:2000年12月~2004年2月,收治22例创伤性髌骨不稳患者,其中男性7例,女性15例;年龄16~33岁(平均23.7岁);所有患者在第一次脱位时均有外伤史,术前脱位次数3~7次。术中先进行关节镜检查,评估髌骨轨迹和髌股关节的动态匹配关系,确认MPFL损伤部位后进行修复,并于关节镜下监视调整MPFL的张力。髌骨外侧支持带明显紧张者行关节镜下外侧支持带松解。术后经正规康复治疗。随访24~38个月(平均28.6个月),根据Larsen评分评价术后膝关节功能。结果:22例膝关节术后髌股匹配关系均获得重建,随访期内未发生髌骨再脱位。根据Larsen评分,优18例、良4例。结论:修复MPFL对于创伤性髌骨不稳具有良好的疗效,关节镜是保证手术成功的重要辅助手段。     

髌骨倾斜导致髌股关节接触压力与面积改变

我们采用压敏片测量技术对髌骨倾斜状态下髌股关节的生物力学变化特点进行了研究。７例新鲜人尸体标本采用手术方法将髌外侧支持带紧缩造成髌骨外侧倾斜状态，超低压型压敏片置于髌股关节之间，等长加载２００Ｎ，分别在正常状态及髌骨倾斜状态下于屈膝３０°、６０°、９０°、１２０°时测量髌股关节接触压力与面积。结果表明：髌骨倾斜后使髌股关节原正常的“哑铃型”接触压迹转变为“彗星尾状”，外侧面孤立接触，内侧面接触区减少或失接触，接触压力改变表现为髌内侧软骨面接触压力减少或消失，外侧面接触压力集中且明显增高上述改变均以屈膝３０°时最明显。实验结果提示：各种纠正髌骨倾斜状态及治疗髌骨软骨软化症的手术方法，必须以恢复髌骨内外侧关节面压力平衡为标准，特别是屈膝３０°时病理力学的改善最为重要     

High-resolution MRI using a microscopy coil for the diagnosis of recurrent lateral patellar dislocation

Purpose Magnetic resonance imaging (MRI) has been commonly used for the preoperative evaluation of recurrent lateral patellar dislocation (RLPD). The purpose of this study was to determine the usefulness of high-resolution MRI (HR-MRI) with a microscopy coil for diagnosing RLPD. Materials and methods The study group consisted of 15 patients with clinically diagnosed RLPD and 10 normal volunteers. All studies were performed on a 1.5-T MR system. First, conventional MRIs of the whole knee joint were obtained using the knee coil. Then HR-MRI scans using a microscopy coil in the medial aspect of the patella were obtained at the level of the superior pole of the patella, targeting the medial patellofemoral ligament (MPFL). The acquired HR-MRIs with RLPD were reviewed concerning the MPFL injury and the patellar injury. Results The MPFL was distinguished as a separate ligament, and the layer structure of the patellar cartilage was visualized clearly in all volunteers. The MPFL injury was visualized in 12 cases (87%); it included discontinuity, thickening, and loosening. The patellar injury was visualized in 11 cases (73%), which included dissecans of the medial margin and cartilage injuries. Conclusion HR-MRI with a microscopy coil provides precise information of the MPFL and patellar cartilage injury for the diagnosis of RLPD.     

Transient medial patellar dislocation: injury patterns at US and MR imaging

Medial dislocation of the patella is an unusual entity. It is usually an iatrogenic complication of surgical lateral retinacular release. We describe the clinical, ultrasound (US), and magnetic resonance (MR) imaging features of a transient medial patellar dislocation in a 19-year-old patient with trochlear groove dysplasia presenting no surgical history. US showed acute injury to the lateral patellar retinaculum with complete avulsion at its patellar insertion. MR imaging confirmed the complete tear of the lateral patellar retinaculum and disclosed contusion of the anteromedial portion of the medial femoral condyle and lateral patella. This case is noteworthy because the injury patterns of patellar soft tissue restraints differ markedly from the classical features of lateral patellar dislocation.