Department of Emergency Medicine, McGill University, Montreal, Quebec, Canada.
Department of Orthopedic Surgery, McGill University, Montreal, Quebec, Canada.
Am J Emerg Med. 2014 Jan;32(1):109.e3-4. doi: 10.1016/j.ajem.2013.08.023. Epub 2013 Sep 26.
A small truck collided with a 67-year-old female pedestrian. She sustained blunt, closed trauma to her right knee, and developed a prepatellar Morel-Lavallée lesion (MLL). A MLL is a closed soft tissue degloving injury, resulting from high-energy shearing forces, which separate the skin and subcutaneous tissue from the underlying fascia. The resultant space collects fluid and is prone to infection, tissue necrosis, and symptoms of ongoing mass effects. The diagnosis is elusive because of its rarity and often subtle initial symptoms. Prompt diagnosis is critical, given the potentially severe complications when missed, and less invasive and more successful treatment when found early. Most reported cases are proximal to the pelvis, whereas the few reported peri–knee MLLs involve young athletes or postsurgical complications. To our knowledge, this is the third reported case of a non–sport-related MLL of the knee, all of which involved high-inertia force to the knee. Therefore, MLL of the knee should be considered in patients with knee trauma, particularly in the setting of pedestrians struck by motor vehicles.
一辆小卡车与一名 67 岁女性行人相撞。她的右膝受到钝性闭合性创伤，并发髌前莫尔加莱耶（Morel-Lavallée）损伤（MLL）。MLL 是一种闭合性软组织撕脱伤，由高能剪切力引起，导致皮肤和皮下组织与下面的筋膜分离。由此产生的空间会积聚液体，容易感染、组织坏死，并出现持续的肿块效应症状。由于其罕见性和最初症状常常不明显，因此诊断较为困难。鉴于漏诊时可能会出现严重并发症，而早期发现时治疗更微创且成功率更高，因此及时诊断至关重要。大多数报道的病例发生在骨盆附近，而少数报道的膝关节周围 MLL 则涉及年轻运动员或手术后并发症。据我们所知，这是第三个报道的膝关节非运动相关 MLL 病例，所有这些病例都涉及对膝关节的高惯性力。因此，对于膝关节创伤患者，特别是机动车撞击行人的情况下，应考虑膝关节 MLL。
