髌骨骨软骨骨折的诊治策略

Diagnosis and treatment of osteochondral fractures of the patella

目的探讨髌骨骨软骨骨折的临床特征、诊治要点和治疗方法。方法2002年10月至2006年12月，采用手术治疗21例髌骨骨软骨骨折患者，其中17例新鲜骨折，以钢丝内固定2例，以2—3枚AO微型螺钉固定4例，Ethicon可吸收缝线固定4例，以1～2枚小的可吸收螺钉固定5例，2例行膝关节镜检手术；4例陈旧性骨折中，2例切开予以行髌骨内侧关节面修整，游离骨折块清除，1例行关节镜手术取出小骨块，另1例行AO微型螺钉内固定术。结果21例平均随访32．3个月（12～48个月），20例骨折均愈合，愈合时间6～10周，平均8周。膝关节功能完全恢复正常20例，膝关节疼痛、活动受限1例。按照Lysholm膝关节功能评分标准：优15例，良2例，可4例，优良率为80．9％。结论临床中髌骨骨软骨骨折易漏诊与误诊，应用CT薄层扫描、MRI及关节镜检查可避免。确诊后应及早手术，切开复位、应用可吸收螺钉和可吸收缝线固定或关节镜检手术，是效果良好的治疗方法。

Objective To assess the clinical characteristics, diagnosis and curative methods of osteochondral fractures of the patella. Methods From October 2002 to December 2006, 21 patients with osteochondral fracture of the patella were operatively treated in our department. Of the 17 fresh fractures, 2 received wire internal fixation, 4 fixation with 2 to 3 AO mini-screws, 4 fixation with Ethicon absorbable suture, 5 fixation with 1 to 2 tiny absorbable screws, and 2 knee arthroscopy. Of 4 old fractures, 2 underwent open repair of medial patellar surface and removal of free bone debris, 1 arthroscopy to remove bone fragments and 1 internal fixation with AO mini-screws. Results The patients were all followed up for 32.3 （12 to 48） months on average. Twenty cases got bony healing and complete functional recovery. Only 1 case had knee pain and motion limitation. Conclusions Osteochondral fractures of the patella are likely to be misdiagnosed. Thin CT, MRI, and arthroscopy can help avoid misdiagnosis. Operation should be performed once diagnosis is confirmed. Open reduction, internal fixation with absorbable screws or suture, and arthroscopy are effective methods to treat the disorder.