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老年患者的膝关节交锁与髌骨下脱位:一例病例报告及文献综述

Locked Knee and Inferior Patellar Dislocation in an Elderly Patient: A Case Report and Review of the Literature.

作者信息

Silver Jeremy, Sain Jared, Simon Michael, Swan Kenneth G

机构信息

Rutgers Robert Wood Johnson Medical School, Department of Orthopaedic Surgery, New Brunswick, NJ.

出版信息

J Orthop Case Rep. 2025 Jul;15(7):102-106. doi: 10.13107/jocr.2025.v15.i07.5784.

DOI:10.13107/jocr.2025.v15.i07.5784
PMID:40635969
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12237489/
Abstract

INTRODUCTION

Inferior patellar dislocations in elderly patients are rare and typically occur in the presence of significant patellofemoral arthritis. These dislocations often present as a locked knee, which can be mistaken for other knee pathologies. While treatment has generally involved closed reduction, there is limited literature on recurrence and the role of surgical intervention.

CASE REPORT

An 85-year-old female presented with a locked right knee following a fall, unable to bear weight or extend the knee. Radiographs and MRI revealed an inferior patellar dislocation due to a superior patellar osteophyte interacting with a defect in the lateral femoral condyle. Initial closed reduction was successful but followed by a recurrence of the dislocation seven weeks later. Arthroscopic surgery, including debridement of the patellar osteophyte and trochlear osteochondral defect, provided definitive treatment. The patient remained symptom-free at 12 months follow-up with no further dislocations.

CONCLUSION

This case highlights the challenge of managing inferior patellar dislocations in elderly patients, with closed reduction and immobilization often insufficient to prevent recurrence. Arthroscopic surgery should be considered in cases of recurrent dislocation to allow for early mobilization and minimize the risk of further episodes.

LEVEL OF EVIDENCE

Level V Case Report.

摘要

引言

老年患者的髌下脱位很少见,通常发生在存在严重髌股关节炎的情况下。这些脱位常表现为膝关节交锁,可能被误诊为其他膝关节病变。虽然治疗通常包括闭合复位,但关于复发和手术干预作用的文献有限。

病例报告

一名85岁女性跌倒后出现右膝关节交锁,无法负重或伸直膝关节。X线片和磁共振成像显示由于髌骨上的骨赘与股骨外侧髁的缺损相互作用导致髌下脱位。最初的闭合复位成功,但7周后脱位复发。关节镜手术,包括清除髌骨骨赘和滑车骨软骨缺损,提供了确定性治疗。在12个月的随访中,患者无症状,未再发生脱位。

结论

本病例突出了老年患者髌下脱位治疗的挑战,闭合复位和固定往往不足以防止复发。对于复发性脱位病例,应考虑关节镜手术,以便早期活动并将进一步发作的风险降至最低。

证据级别

V级病例报告。

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本文引用的文献

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Unusual total knee immobilization in an elderly patient due to inferior patella dislocation: Case report and review of the literature.老年患者因髌骨下脱位导致的罕见全膝关节固定:病例报告及文献综述
Trauma Case Rep. 2021 Apr 23;33:100481. doi: 10.1016/j.tcr.2021.100481. eCollection 2021 Jun.
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Inferior dislocated patella locked by a loose body.下脱位髌骨被游离体卡住。
BMJ Case Rep. 2021 Apr 8;14(4):e240471. doi: 10.1136/bcr-2020-240471.
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Intra-Articular Patellar Dislocation: A Technique for Closed Reduction: A Case Report and Review of the Literature.
关节内髌骨脱位:一种闭合复位技术:病例报告及文献综述
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Inferior dislocation of patella after a total knee replacement-a case report.全膝关节置换术后髌骨下脱位——一例报告
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Inferior dislocation of the patella: an unusual cause of a locked knee.髌骨下脱位:膝关节交锁的一种罕见病因。
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Inferior dislocation of the patella in the degenerate knee.
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Diagnosing the acutely locked knee.诊断急性锁定膝关节。
Injury. 2002 Jul;33(6):495-8. doi: 10.1016/s0020-1383(02)00081-5.