髌骨骨软骨骨折的诊治策略

目的 探讨髌骨骨软骨骨折的临床特征、诊治要点和治疗方法 .方法 2002年10月至2006年12月,采用手术治疗21例髌骨骨软骨骨折患者,其中17例新鲜骨折,以钢丝内固定2例,以2～3枚AO微型螺钉固定4例,Ethicon可吸收缝线固定4例,以1～2枚小的可吸收螺钉固定5例,2例行膝关节镜检手术;4例陈旧性骨折中,2例切开予以行髌骨内侧关节面修整,游离骨折块清除,1例行关节镜手术取出小骨块,另1例行AO微型螺钉内固定术.结果 21例平均随访32.3个月(12～48个月),20例骨折均愈合,愈合时间6～10周,平均8周.膝关节功能完全恢复正常20例,膝关节疼痛、活动受限1例.按照Lysholm膝关节功能评分标准:优15例,良2例,可4例,优良率为80.9%.结论 临床中髌骨骨软骨骨折易漏诊与误诊,应用CT薄层扫描、MRI及关节镜检查可避免.确诊后应及早手术,切开复位、应用可吸收螺钉和可吸收缝线固定或关节镜检手术,是效果良好的治疗方法 .     

可吸收固定棒联合带线锚钉治疗伴有骨软骨骨折的创伤性髌骨脱位

目的 探讨可吸收固定棒联合带线锚钉治疗伴有骨软骨骨折的创伤性髌骨脱位的临床疗效。方法 回顾性分析2018年1月～2021年10月25例创伤性髌骨脱位导致骨软骨骨折合并内侧髌股韧带(medial patellofemoral ligament, MPFL)损伤的资料。用可吸收固定棒复位固定骨软骨骨折，带线锚钉缝合修复MPFL。术后用膝关节活动度、Lysholm和IKDC膝关节评分及Bostman髌骨骨折功能评分标准评判关节功能，用CT、MRI评价骨折愈合情况、髌骨位置、MPFL连续性及信号。结果 术后随访12～18个月，平均14个月，无髌骨脱位复发。按Bostman髌骨骨折功能评分标准，优22例，良2例，差1例。术后12个月膝关节活动度、Lysholm评分、IKDC评分均较术前明显改善(均P=0.000)。影像学检查显示骨软骨损伤和MPFL愈合良好。结论 对于合并髌骨骨软骨骨折的创伤性髌骨脱位，一期可吸收固定棒复位固定骨折块联合锚钉紧缩缝合MPFL临床疗效确切。     

可吸收软骨钉多点固定治疗髌骨不稳致骨软骨骨折

目的 :观察可吸收软骨钉多点固定治疗髌骨不稳所致骨软骨骨折的疗效。方法 :自2014年8月至2016年9月收治21例髌骨脱位所致骨软骨骨折患者,其中男7例,女14例;年龄12~42岁,平均27岁。采用开放手术找到游离软骨骨折块,行可吸收软骨钉内固定术联合外侧支持带松解内侧支持带紧缩术治疗。术前、术后随访行Lysholm评分评定膝关节功能,对数据进行回顾性分析。结果:所有患者手术顺利,术后随访8~22个月,平均12个月。术后CT及X线检查示骨折块位置良好。21例患者均基本恢复伤前运动水平,膝关节Lysholm评分达86.11±4.97。结论:由髌骨不稳所致骨软骨骨折采用可吸收软骨钉能有效固定游离软骨块,操作简单、疗效满意,具有良好的临床推广意义。     

可吸收棒治疗髌骨脱位骨软骨骨折的临床疗效

目的探讨研究应用可吸收棒固定治疗青少年创伤性髌骨脱位引起的骨软骨骨折在有效康复治疗后的临床疗效。 方法回顾性研究因创伤性髌骨脱位导致的骨软骨骨折而采用可吸收棒固定治疗的患者。所有患者均是在2012到2014期间在内蒙古医科大学第二附属医院因骨软骨骨折接受手术治疗,纳入标准：髌骨脱位伴随骨软骨骨折,年龄小于18岁;排除标准：年龄大于18岁,髌骨脱位以外的原因引起的骨软骨骨折。所有患者术前均经过MRI检查。本组共纳入15例患者,女性11例,男性4例,平均(14.6±1.8)岁,其中11例患者的骨软骨骨折块来自髌骨,4例患者的骨软骨骨折块发生在股骨的外侧髁。所有15例患者的骨软骨骨折均行切开复位可吸收棒固定治疗,术后患肢采用石膏固定制动,所有患者的康复均采用统一治疗的方案。使用膝关节损伤和骨关节炎评分(KOOS),国际膝关节文献委员会膝关节评估表(IKDC),膝关节运动评分(Tegner)对手术前及随访时的膝关节进行评估,术前和随访时数据采用配对t检验分析。 结果15例患者全部骨性愈合,术后经合理康复后15例患者均无并发症的发生,随访时间平均为(2.4±0.7)年,术前评分KOOS(71.2±6.2),IKDC(74.1±6.0),Tegner(4.1±1.7),随访时KOOS评分(86.9±5.8),IKDC评分(88.7±6.1),Tegner评分(5.9±1.6),较手术前明显改善,差异有统计学意义(t ＝－8.6、－6.3、－7.1, P<0.05)。 结论可吸收棒固定治疗骨软骨骨折在有效康复后临床疗效可靠,通过中期的随访,具有较高的骨性愈合率,没有接受二次手术的患者。     

用可吸收螺钉治疗髌骨骨软骨骨折

【摘要】〓目的〓探讨髌骨骨软骨骨折用可吸收螺钉手术固定方法及其疗效。方法〓我院2004年6月~2009年12月共收治了14例急性膝关节外伤患者,年龄13~21岁(男3,女11;左膝8例,右膝6例)。经CT检查8例、MRI检查6例确诊髌骨骨软骨骨折。手术发现股骨外髁软骨挫伤及划痕;髌骨内侧松弛,骨软骨骨折。所有患者均采用手术复位及可吸收螺钉固定。术后24小时开始股四头肌收缩训练,外固定保护3周膝关节无负重活动。2~3月CT或X显示骨软骨下骨折块愈合后负重功能锻炼。 结果〓12例获得4~9年随访,平均6.5年,使用HSS标准评价优11例,良1例。结论〓髌骨骨软骨骨折早期诊断、手术复位用可吸收螺钉内固定可靠;早期功能锻炼,晚负重行走,疗效良好。     

软骨块内固定术结合持续被动活动治疗新鲜髌骨软骨骨折

目的 探讨新鲜髌骨软骨骨折的治疗方法。方法 对新鲜髌骨软骨骨折１１例,施行骨折的游离软骨块复位内固定,术后应用持续被动活动装置活动膝关节５周。结果 经平均２８个月的随访,１１例中,术后膝关节功能优９例,良１例,优良率９０．９％。结论新鲜髌骨软骨骨折采用游离软骨块复位内固定和ＣＰＭ治疗是可行的,疗效满意。     

髌骨骨-软骨骨折诊治分析

髌骨骨-软骨骨折因骨折块较小,X线片不易显示,容易漏诊。其骨折块于关节腔内形成游离体,若不及时处理对膝关节危害较大。我们2000年5月～2004年6月治疗髌骨骨-软骨骨折55例,疗效良好。     

PDSⅡ三角固定法治疗髌骨骨软骨骨折11例

目的探讨三角固定法治疗髌骨骨软骨骨折的优势,并在临床得到推广应用。方法对自2010-07—2013-07收治的11例髌骨骨软骨骨折行PDSⅡ三角固定法,膝关节功能评估依据Lysholm评分和Tegner运动评级。结果患者均骨性愈合,无髌骨习惯性脱位,膝关节活动度正常。Lysholm评分术前为(41.3±5.35)分,术后为(79.21±5.33)分。Tegner分级术前为0~3级(1.33±0.81)。术后为3~7级(4.21±1.12)。术后Lysholm评分和Tegner运动评级较术前显著提高。结论PDSⅡ三角固定法操作简便,加压均匀,骨块不易旋转、碎裂,是治疗髌骨骨软骨骨折可行的手术方法。     

外固定减张结合骨块缝合治疗髌骨下极骨折

髌骨下极骨折是发生于髌骨远端的骨折,为髌骨骨折中较特殊类型的关节内骨折,多为粉碎性骨折,可以带有少许关节软骨面,手术方式的选择直接关系到膝关节功能的恢复.自2006年4月至2008年4月,采用体外减张固定结合骨块缝合手术治疗18例髌骨下极骨折,效果良好,现报道如下.     

髌骨骨软骨骨折3例报告

髌骨骨软骨骨折是髌骨骨折的一种特殊类型,较少见,指髌骨关节面骨软骨撕脱或剥脱性骨折。由于骨折块较小,含有部分软骨,Ｘ光片时有显示不清,以致病情误诊、漏诊,处理不当将导致膝关节创伤性关节炎,１９９２年以来曾收治本病５例,将其中３例诊治经验教训报告如下。 临床资料 例１,男性,３０例,因左膝部撞伤肿痛６ｗ入院。缘于骑摩托车追尾,右膝屈膝撞于客车后箱板,伤后右膝部肿胀,髌骨下缘压痛,屈膝９０度受限,浮髌试验阳性,右膝正侧位Ｘ光片未见骨折,用下肢右膏托固定了３ｗ、伤后６ｗ右膝仍痛,髌骨下缘压痛,再次摄Ｘ片…     

Die Patellaluxation als Ursache osteochondraler Frakturen im femoropatellaren Gleitlager

Acute traumatic dislocation of the patella may be associated with osteochondral fractures. Clinical examination invariably shows a tense effusion. A detailed radiographic examination including antero-posterior, lateral and skyline views of the patella is usually necessary to establish an exact diagnosis. Once diagnosis is made open reduction and fixation of the osteochondral fracture should be carried out if it is possible. Out of 78 patients of our own with patella dislocation 24 cases suffered an osteochondral fracture. In ten cases refixation of the osteochondral fragment was achieved. Intraoperatively the alignment of the patella was controlled in any case. In cases of lateral subluxation lateral release and medial reconstruction was performed. In two cases medial transfer of the tibial tuberosity was carried out. Osteochondral fractures of the femoro-patellar groove represent an important injury in the course of acute patellar dislocation. With exact diagnosis and correct treatment congruity of the femoro-patellar joint can be restored in many cases.     

Isolated osteochondral fracture of the patella without patellar dislocation

Chondral fractures of the patella are associated with acute dislocation of the patella. Osteochondral fracture in patellar dislocation is located in the medial facet of the patella. This article presents a case of a 15-year-old female ballerina with isolated displaced osteochondral fracture of the patella without patellar dislocation. She had no history of trauma. A Merchant's view of both knees showed mild subluxation of the patella, a small fragment on the lateral aspect of the knee, and a small defect of the centromedial patella. Axial magnetic resonance imaging (MRI) revealed an osteochondral fragment measuring 13 mm medial to the patella. However, the medial patellofemoral ligament and medial retinaculum were intact. An effusion on the medial side of the patella consistent with hemarthrosis was observed. An absence of a contusion or bone bruise on the lateral femoral condyle was shown. The loose body was removed arthroscopically. Intraoperative findings included a 1.5×2 cm osteochondral fragment. It is unusual that the osteochondral patellar defect site in this patient was in the inferior and central areas of the patella. Patellar chondral fractures without dislocation or patella fracture are rare. Therefore, the possibility of a trivial trauma leading to an osteochondral fracture should be kept in mind in adolescent and young adults who present with knee pain and hemarthrosis.     

Extra-articular Synovial Fluid Extravasation Following Operative Fixation of an Osteochondral Fracture of the Patella

Osteochondral fracture of the patella following a lateral patellar dislocation can be treated with operative and nonoperative techniques that are dictated by the clinical presentation. In the presence of large fragments following acute fractures, arthroscopic retrieval and fixation are advocated, whereas smaller displaced fragments may be removed and discarded as loose bodies. Several methods of fixation exist for osteochondral fractures of the patella, including the use of cannulated and noncannulated screws.This article describes a case of an elite competitive swimmer who sustained a lateral patellar dislocation with a large osteochondral fracture of the patella that was treated with open reduction and fixation using absorbable cannulated screws in an inside-out fashion. In the early postoperative period, the patient developed a symptomatic synovial fluid fistula through a cannulated screw to the prepatellar space. The diagnosis of this condition was made clinically and confirmed with noncontrast magnetic resonance imaging 6 weeks postoperatively. The symptoms of pain, skin erythema, and swelling were self-limited and eventually resolved with observation, allowing the athlete to return to his previous activity level. Magnetic resonance imaging 3 years postoperatively showed the complete resolution of the fluid extravasation.Extra-articular synovial fluid extravasation is as a rare complication following routine knee arthroscopy, accounting for 3.2% of the complications. This article describes a rare, self-limited complication following open fixation of an osteochondral fracture of the patella.     

W形克氏针结合张力带钢丝内固定治疗髌骨骨折

目的探讨W形克氏针结合张力带钢丝内固定治疗髌骨骨折的临床疗效。方法对38例髌骨骨折患者采用髌前纵行切口,骨折复位后均行W形克氏针结合张力带钢丝内固定。结果 38例均获随访,时间8-24个月。骨折均达骨性愈合,髌骨关节面光整,无克氏针旋转、内固定物松动、断裂等并发症发生。关节功能根据Lysholm膝关节评分标准：优36例,良2例。结论 W形克氏针结合张力带钢丝内固定治疗髌骨骨折预防了改良张力带由于克氏针的旋转刺破皮肤而影响功能恢复等并发症发生。该方法操作方便,创伤小,固定牢靠,能早期活动,符合生物力学原理,临床疗效满意。     

镍钛聚髌器与可调节整复器治疗髌骨骨折比较

目的 比较两种髌骨骨折内固定器的疗效。方法 手术治疗髋骨骨折208例,其中11例采用镍钛聚髌器内固定,95例采用可调节髌骨骨折整复器内固定。结果 镍钛聚髌器内固定组：优99例,良10例,中2例,差2例;可调节髌骨骨折整复器内固定组：优83例,良8例,中2例,差2例。两组间差异无显著性。结论 镍钛聚髌器和可调节髌骨骨折整复器的均有良好的疗效。     

前侧入路直视关节面复位内固定治疗粉碎性髌骨骨折

目的总结前侧入路直视关节面复位内固定治疗粉碎性髌骨骨折的疗效。方法采用前侧入路直视关节面复位内固定手术治疗31例粉碎性髌骨骨折患者。结果31例均获得随访,时间6~26个月。均未发生骨折再移位、内固定松动及断裂、感染等并发症。骨折愈合时间8~12周。结论前侧入路直视关节面复位内固定治疗粉碎性髌骨骨折恢复快、并发症少。     

Osteochondral fracture of the patella without soft tissue injury and with no dislocation: A case report

IntroductionOsteochondral fracture of the patella is a fairly common pathology, but almost always associated with a spectrum of soft tissue injuries including anterior cruciate ligament (ACL) rupture. We present a rare case of an osteochondral fracture of the patella in the absence of ligament or soft tissue injuries and with no dislocation of the patella in a pediatric patient.Presentation of caseAn 11-year-old male presented to the orthopedic clinic on crutches following a football injury. The patient had pain in his left knee with flexion deformity. Plain film radiography of the left knee was taken, and an osteochondral fracture of the patella was suspected. Further imaging studies were conducted including computed tomography (CT) and magnetic resonance imaging (MRI) which revealed an isolated osteochondral fracture of the patella with no other associated injuries. Open reduction and internal fixation of the displaced fragment was successfully preformed with favorable outcomes. During follow-up, almost full range of motion was regained, and plain film radiography revealed healed fracture with a normal appearance of the patella.DiscussionTraumatic osteochondral fracture of the patella is a common injury and most of these injuries are commonly accompanied by an acute dislocation of the patella or soft tissue injuries such as rupture of the anterior cruciate ligament (ACL) and almost half of all patellar dislocations incidence are associated with osteochondral fractures of the patella. This case had an isolated osteochondral fracture of patella.ConclusionAs demonstrated in this case, osteochondral fractures are common among younger population and patients need to be thoroughly evaluated. Advanced Imaging such as MRI and CT are essential to exclude soft tissue injuries. Although management is highly variable, the importance of open reduction and early fixation should be emphasized for optimal outcomes.     

Proximal Tibial Sleeve Fracture: Case Report of a Rare Injury and Review of the Literature

A sleeve fracture occurs when a ‘‘sleeve’’ of cartilage or periosteum is avulsed with or without an osseous fragment, an injury most commonly reported in the patella. Proximal tibial sleeve fractures are extremely rare and we present a case in an adolescent male who had concomitant osteochondral as well as chondral fractures of his patella. Sleeve fractures present in the skeletally immature, and may look relatively benign on radiographs, but misdiagnosis may lead to adverse consequences. Clinicians should have a high index of suspicion if a child or adolescent presents with a knee injury with clinical concerns regarding the extensor mechanism. Given that the ‘‘sleeve’’ of the injury contains tissue with osteogenic potential, we recommend that displaced proximal tibial sleeve fractures should be managed operatively to avoid dysfunction of the extensor mechanism. These patients should also have perioperative assessment for occult osteochondral and chondral injuries that are potentially repairable and thus may have implications for prognosis.