【作者】 王永琨；

【导师】 于庆巍；

【作者基本信息】 吉林大学 ， 外科学， 2012， 硕士

【摘要】 目的髌骨骨软骨骨折临床少见，属于关节内骨折，严重影响关节功能，临床上诊断困难，容易漏诊误诊，治疗不当可引起创伤性关节炎等严重并发症，本文探讨髌骨骨软骨骨折的诊断、可吸收缝合线固定髌骨软骨骨折的体会。方法通过一组使用关节镜确诊髌骨骨软骨骨折，并用可吸收线固定骨折块治疗前后得到的临床数据资料进行回顾性分析研究。吉林大学中日联谊医院骨科2009年10月-2011年10月诊治髌骨软骨骨折患者4例，男性1例，女性3例；年龄15～40岁，平均21.25岁。左侧1例，右侧3例。术前误诊3例，确诊1例。下楼梯摔倒扭伤1例，穿高跟鞋扭伤1例，急速奔跑屈曲摔倒受伤2例。其中1例伴有髌骨习惯性脱位。受伤时间3-18天，平均8天。骨折快大小（2.0-3.0）cm×(2.0-2.5)cm。每例患者手术前后均进行国际上认可的Lysholm和Tegnen膝关节功能评分，同时对患者的恢复后症状，对工作及生活的影响进行评价。结果所有患者术后均无早期并发症发生。所有患者术后均获得随访，3例行门诊随访，1例行电话随访。随访时间8.1~28.3(18.1±8.3)个月。截至写稿时，所有随访患者膝关节稳定，膝关节肿胀疼痛、绞索等症状消失，活动度同健侧12周后关节活动度全面恢复，恢复正常生活、工作或学习。Lysholm评分术前（31.00±11.60）分，术后3个月（84.00±6.92）分，术后6个月（97.75±2.62）分； Tegner评分术前（3.00±0.81）分，术后3个月（8.25±0.96）分，术后6个月（9.25±0.50）分。术后6个月疗效优4例，占100%;总优良率为100%。结论髌骨骨软骨骨折术前误诊率高。关节镜可以确诊并辅助手术治疗。可吸收缝合线固定髌骨骨软骨骨折块可避免软骨缺损，术中操作简便、安全，固定可靠，术后风险小，短期内症状改善明显，优良率100%，远期疗效需要进一步观察。更多还原

【Abstract】 Objective： To sum up diagnosis of Patella osteochondralfracture and treatment experience of fixation with dissolvablesutures, which is Belong to intra-articular fractures, easily causemisdiagnosis or missed diagnosis due to clinical rare and difficult todiagnose,also adversely affects joint function even lead to severecompications such as traumatic arthritis.Methods: a set of clinical data analysis were retrospectivelyreviewed and obtained before and after arthroscopic diagnosis asPatella osteocondral fracture and fixation with dissolvable sutures.China-Japan Union Hospital in October2009on October-2011diagnosed as Patella osteochondral fracture were screened，4caseswere included,1males and3females; The mean age is21.25years(15-40years),7left and3right knee were examined. Preoperatively3cases were misdiagnosed and1case was diagnose.Among thesepatients1case twisted knee as walking down stairs,1case sprainher knee with high-heeled shoes,2cases fell down and hurt kneeswith flexion posture while fastly running.one of4cases complainedof habitual dislocation of patella.The mean time between traumahappening and clinic visiting is8days(3-18days).The sizes offractures varied:(2.0-3.0)cm×(2.0-2.5)cm. Each patient before andafter surgery was rated with Tegner and Lysholm knee score whichwere internationally recognized.Meanwhile,the postoperativesymptoms and signs,effects on life and work were assessed. Results: All patients had no early complications. Allpatients were followed up after surgery,3patients for outpatientfollow-up,1patients received telephone follow-up.Follow-up timeis8.1~28.3(18.1±8.3). At press time,all patients have good kneejoint stability and return to normal life and work.Ache,swelling andlocking symptoms of joints disappear moreover range of motionafter12weeks recovers as well as the one of contralateral side.Lysholm score mproved from（31.00±11.60）before surgery to(84.00±6.92) after3months and （97.75±2.62）after6months.Tegner score mproved from（3.00±0.81）before surgery to(8.25±0.96) after3months and（9.25±0.50）after6months.After6months all patients gained excellent efficacy which account for100%.Conclusions: Although preoperative misdiagnosis rate israther high, Patella osteocondral fracture could be diagnosed byarthroscopy which also can aid in healing. fracture fixed withdissolvable sutures could avoid osteochondral defect,otheradvantages are safe,easy to operate,well fixation,low risk,obviousimprovement of symptoms with a100%excellent and good rate inshort term. The clinical efficacy of long-term treatment requiresfurther observation.更多还原