Dixit Sameer, Deu Rajwinder S
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
Sports Med Arthrosc Rev. 2017 Jun;25(2):72-77. doi: 10.1097/JSA.0000000000000149.
The treatment of patellar instability is challenging and typically begins with nonoperative methods. Clinical decisions are made on an individual basis and may vary according to a number of factors. First-time patellar dislocations most commonly occur during sports participation. Initial evaluation, including patient history, physical examination, and appropriate imaging, determines care. Although nonoperative treatment consists primarily of regressive immobilization and physical therapy, there is little evidence to support particular protocols for either. Factors that may contraindicate nonoperative treatment include osteochondral lesions and recurrent instability. In these cases, surgery is considered. Reported recurrence rates after nonoperative treatment of acute patellar dislocation are 15% to 44%. Well-designed studies are needed to determine not only the outcomes of nonoperative versus surgical treatment of patellar instability but also the risk factors that may predict poor outcomes in either group.
髌骨不稳定的治疗具有挑战性，通常从非手术方法开始。临床决策是根据个体情况做出的，可能会因多种因素而有所不同。首次髌骨脱位最常发生在运动过程中。初始评估，包括患者病史、体格检查和适当的影像学检查，决定治疗方案。虽然非手术治疗主要包括渐进性固定和物理治疗，但几乎没有证据支持这两种方法的特定方案。可能禁忌非手术治疗的因素包括骨软骨损伤和复发性不稳定。在这些情况下，考虑进行手术。急性髌骨脱位非手术治疗后的报告复发率为15%至44%。需要精心设计的研究，不仅要确定髌骨不稳定非手术治疗与手术治疗的结果，还要确定可能预测两组不良结果的风险因素。
