摘要
目的:分析复发性髌骨外侧脱位误治后出现髌骨向内侧脱位的临床特点、诊断、治疗及误治原因,提出防范误治建议。方法:选择1例复发性髌骨外侧脱位行手术治疗后出现髌骨内侧脱位,后进行翻修手术纠正脱位的病例,回顾相关文献,分析误治原因。结果:患者入院后考虑左侧复发性髌骨脱位,行左侧膝关节髌骨外侧支持带松解+胫骨结节内移截骨术,后患者屈膝时出现髌骨向内侧脱位,返院行左侧膝关节髌骨脱位翻修+外侧支持带紧缩术,术后膝关节稳定性恢复。结论:髌骨脱位属少见病、疑难病,临床医师应规范诊断,细致查体,严控手术指征,通过CT配合三维有限元分析软件对股骨前倾角、胫骨外旋角进行精确测量,结合MRI测量其胫骨结节-股骨滑车间距离(tuberositas tibae-trochlearrgroove distance,TT-TG),充分预估患者下肢力线扭转程度与骨性结构异常程度,进行完善的术前设计,采用合理的术式,术中谨慎操作,避免误诊、误治。
Objective:To analyze the clinical features,diagnosis,treatment and mistreatment of recurrent lateral patella dislocation with medial dislocation,and to put forward some suggestions for prevention of mistreatment.Methods:One case of recurrent patellar lateral dislocation were reported.After surgery the patient occurred medial patellar dislocation.This case were corrected by revision operation.Reviewing the related literature,and discuss the causes of mistreatment.Results:The patient was diagnosed with recurrent dislocation of the left patella was treated with medial patellar support band reefing,lateral support band loosening,femoral condyle trochlear molding,tibial tuberosity adduction after admission,then medial patellar dislocation occurred and a revision surgery was applied to recover the patient′s knee joint stability.Conclusion:The patellar dislocation is a rare disease and difficult to solve.The normalization of diagnosis,meticulous physical examination,strictly controlled indication of operation is very important.With the CT scanning and 3Dfinite element analyzing to measure the femur anteversion angle and the tibial lateral rotation angle accurately,and measure the TT-TG(tuberositas tibae-trochlearrgroove distance)by MRI to improve the preoperative design,apply reasonable and careful operation to avoid misdiagnosis and mistreatment.
作者
杨新绿
苟凌云
覃智斌
张庆文
方斌
曾广辉
黄国立
YANG Xinlv;GOU Lingyun;TAN Zhibin;ZHANG Qingwen;FANG Bin;ZENG Guanghui;HUANG Guoli(Second Ward of Traumatic Orthopedics,Liuzhou Hospital of Traditional Chinese Medicine,Liuzhou 545000,China;Chinese Medicine Lingnan Orthopaedics Research Center of Guangzhou University;Department of Orthopaedics Surgery,the First Affiliated Hospital of Guangzhou University of Chinese Medicine;The First Clinical Medical College of Guangzhou University of Traditional Chinese Medicine)
出处
《西北国防医学杂志》
CAS
2018年第12期790-793,共4页
Medical Journal of National Defending Forces in Northwest China
基金
广东省科技计划项目(2014A020212556)
关键词
髌骨脱位
误治
关节外科
运动医学
patella dislocation
mistreatment
joint surgery
sports medicine
