成人髌骨骨软骨骨折的治疗

The treatment of osteochondral fracture of patella in adults

目的对成人髌骨骨软骨骨折临床治疗结果进行回顾性分析,总结该病的临床特点及治疗体会。方法回顾性分析自2005年9月至2010年11月间收治的14例成人髌骨骨软骨骨折患者,男性11例,女性3例,年龄18～42岁,平均年龄36.2岁,左侧9例,右侧5例,均为闭合性骨折,交通伤5例,运动伤8例,击打伤1例。所有病例均手术治疗,可吸收钉固定2例,PDS缝线固定5例,可吸收钉加PDS缝线固定1例,骨折块粉碎、压缩、无法固定而骨折块摘除6例。随访骨折愈合及关节功能情况。结果 10例患者获得随访(可吸收钉固定2例,PDS缝线固定3例,可吸收钉及PDS缝线固定1例,骨折块摘除4例),4例失随访,随访时间6周至41个月,平均21.3个月,6例内固定患者骨折均获得骨性愈合,关节活动度恢复正常范围,无明显疼痛症状及髌骨习惯性脱位现象。结论青少年为髌骨骨软骨骨折的高发人群,但近年成人外伤性髌骨骨软骨骨折发病率呈上升趋势,应早期明确诊断、避免漏诊,积极治疗,降低创伤性关节炎的发生率。

Objective To summarize the clinical features and experience in the treatment of osteochondral fracture of patella in adults through the reviewing of clinical outcomes. Methods From September 2005 to November 2010, 14 adult patients （11 males and 3 females） with an average age of 36.2 years （range; 18-42 years） of osteochondral fracture of patella were accepted in our hospital. 6 patients were on the left, and 5 patients were on the right. All the patients were of closed fracture and underwent surgeries. 5 patients were of traffic injury, 8 patients were of sports injury and 1 patient was of impact injury. 2 patients underwent the fixation with absorbable screws. 5 patients underwent the fixation with PDS suture. 1 patients underwent the fixation with absorbable screws and PDS suture. 6 patients underwent the remove of fracture fragments due to the incapable fixation caused by the smash and compression of the fragments. Bone healing and joint function were followed up. Results 10 patients （2 with the fixation of absorbable screws, 3 with the fixation of PDS suture, 1 patients with the fixation of absorbable screws and PDS suture, and 4 patients with the remove of fracture fragments） were followed up, while 4 patients lost the follow-up. The average follow-up period was 21.3 months （range; 6 weeks- 41 months）. Bone healing of the fracture was obtained in 6 patients with internal fixation. Range of motion of the joint recovered to the normal. Neither significant pain nor habitual dislocation of the patella occurred. Conclusions Adolescents are at higher risk of osteochondral fracture of the patella. While due to injuries, the incidence in adults is increasing at present. Early diagnosis should be identified, missed diagnosis should be avoided, active treatment should be applied and the incidence of traumatic arthritis should be decreased.