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急性髌骨脱位的关节镜治疗

Arthroscopic treatment of acute patellar dislocations.

作者信息

Dainer R D, Barrack R L, Buckley S L, Alexander A H

机构信息

Department of Orthopaedic Surgery, Naval Hospital, Oakland, CA 94627-5000.

出版信息

Arthroscopy. 1988;4(4):267-71. doi: 10.1016/s0749-8063(88)80042-2.

Abstract

Twenty-nine patients treated with arthroscopy alone for acute patellar dislocation were reviewed. All had a significant traumatic episode with hemarthrosis in a previously asymptomatic knee. Clinical follow-up averaged 25 months (range 5-64 months). Fifteen patients had concomitant percutaneous lateral release (LR). Significant-sized osteochondral defects not radiographically visible preoperatively were discovered in 40%. Fragments were excised and corresponding craters debrided or abraded. Additional intraarticular pathology discovered included two meniscal tears and one anterior cruciate tear. Overall excellent (E) and good (G) results were 83%. The recurrence rate was 14%, all of which occurred in the LR group. All recurrent dislocations occurred within 1-year post injury. The LR group had 73% G and E results compared with 93% in those without LR. Arthroscopy followed by immobilization was an efficacious approach to acute traumatic patellar dislocations in this specific group of patients. The addition of LR with early motion, however, detracted from the results.

摘要

对29例单纯接受关节镜治疗的急性髌骨脱位患者进行了回顾性研究。所有患者均有明显的外伤史,患膝此前无症状,受伤后出现关节积血。临床随访平均25个月(范围5 - 64个月)。15例患者同时接受了经皮外侧松解术(LR)。40%的患者发现了术前X线片不可见的较大骨软骨缺损。切除碎片并清理或打磨相应的骨坑。发现的其他关节内病变包括2例半月板撕裂和1例前交叉韧带撕裂。总体优良(E)和良好(G)结果为83%。复发率为14%,均发生在LR组。所有复发性脱位均发生在受伤后1年内。LR组的优良结果为73%,而未接受LR的患者为93%。在这一特定患者群体中,关节镜检查后固定是治疗急性创伤性髌骨脱位的有效方法。然而,LR联合早期活动会降低治疗效果。

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