急性髌骨脱位的治疗进展

急性髌骨脱位的治疗方式在骨科医师中一直存在争议,传统的治疗方式为保守治疗,但近年来研究表明保守治疗面临着较高的再脱位率,治疗的方式不应再仅局限于膝关节本身,临床医师应加深和更新对保守治疗方式的认识以降低再脱位率。随着运动医学的不断发展和对髌股关节疾患认识的不断加深,越来越多学者提倡手术治疗,但对于手术方式的选择尚未达成共识。如果没有合并解剖结构的异常,通过修复或重建内侧髌股韧带(medial patella-femoral ligament,MPFL)来恢复髌骨的稳定性变得越来越流行,二者在短期内均可良好地恢复髌骨稳定,但MPFL重建能使髌骨获得更为长期的稳定性,因而使用更为广泛,但仍需研究进一步证实。当急性髌骨脱位合并骨性因素异常时,往往需要联用多种术式进行治疗。目前并没有任何一种尽善尽美的手术方式,应依据个体化情况做出选择,尽可能地恢复髌骨正常的运动轨迹,维持髌股关节的稳定性,最大限度地恢复并维持膝关节功能。本文对急性髌骨脱位的治疗进展及相关问题做一综述,为临床医师选择治疗方案提供参考。

Current therapy progress on the acute patellar dislocation

The treatment of acute patellar dislocation remains a topic of debate among orthopedic surgeons. While conservative treatment has traditionally been favored,recent studies have highlighted the high redislocation rate,prompting a reevaluation of treatment strategies. Current approaches recognize the importance of addressing not only the knee joint but also associated factors contributing to instability. Surgical intervention,particularly focusing on restoring patellar stability through medial patella-femoral ligament (MPFL),repair or reconstruction,has gained popularity. MPFL reconstruction can provide long-term stability of the patella,but further research is needed. When acute patellar dislocation is associated with abnormal bony factors,multiple surgical modalities are often required,with the goal of restoring the normal trajectory of the patella,maintaining the stability of the patellofemoral joint,and optimizing knee joint function. This review provides an overview of advances in the treatment of acute patellar dislocation and related problems,so as to provide reference for clinicians.