Cavalheiro Camila Maftoum, Gobbi Riccardo Gomes, Hinckel Betina Bremer, Demange Marco Kawamura, Pécora José Ricardo, Camanho Gilberto Luis
Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil.
Universidade de São Paulo, Faculdade de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil.
Rev Bras Ortop. 2018 Aug 20;53(5):636-642. doi: 10.1016/j.rboe.2017.04.008. eCollection 2018 Sep-Oct.
Osteochondral fracture after acute patellar dislocation in teenagers is relatively common (up to 60% of cases of patellar dislocation), but poorly diagnosed. There are several treatments proposed for this type of injury, but none well defined in the literature. A male patient, 13 years old, with a diagnosis of osteochondral fracture of the lateral femoral condyle after acute dislocation of the right patella. He underwent surgical treatment of the chondral injury, which consisted of suturing of the chondral fragment to the cartilage defect and, in a second approach, reconstruction of the medial patellotibial ligament and medial patellofemoral ligament with autologous flexor graft. Currently, the patient has been followed up for 16 months postoperatively for the suture of the chondral fragment and for 8 months for the ligament reconstruction. He has been evaluated through functional scores and T2 weighted magnetic resonance imaging. Acute fixation through direct bone suturing of a purely chondral fragment can be considered in special situations.
青少年急性髌骨脱位后发生的骨软骨骨折相对常见(在髌骨脱位病例中占比高达60%),但诊断不足。针对这类损伤提出了多种治疗方法,但文献中均未明确界定。一名13岁男性患者,诊断为右髌骨急性脱位后外侧股骨髁骨软骨骨折。他接受了软骨损伤的手术治疗,包括将软骨碎片缝合至软骨缺损处,以及在第二次手术中用自体屈肌移植物重建内侧髌胫韧带和内侧髌股韧带。目前,该患者软骨碎片缝合术后已随访16个月,韧带重建术后已随访8个月。通过功能评分和T2加权磁共振成像对其进行了评估。在特殊情况下可考虑通过直接骨缝合对单纯软骨碎片进行急性固定。