二分髌骨影像学征象及其法医学意义

Imaging Manifestation and Medicolegal Significance of Bipartite Patella

二分髌骨较罕见,系因青春期二个或多个髌骨骨化中心(化骨核)未融合而形成,临床误诊为骨折的屡有报道。为提高对二分髌骨影像征象的认识,避免法医学鉴定失误,现分析行法医学鉴定的3例二分髌骨资料并结合文献,阐述其形成原因、组织学变化、影像学征象及临床症状体征。3例被鉴定人均为成年,因膝关节外伤后出现膝部疼痛,曾被医疗单位诊断为髌骨骨折,委托损伤鉴定2例,伤残评定1例。依据Saupe’s分型法,其中Ⅲ型2例,Ⅱ型加Ⅲ型1例。在法医学鉴定实践中,熟知二分髌骨影像学征象并与髌骨骨折鉴别,可确保鉴定结论的客观、准确。

Bipartite patella is uncommon in clinical medicine. It is formed by two or more ossification centers which do not fused in adolescence. It is repeatedly misdiagnosed as patellar fracture in clinical practice. In order to elevate the recognition of imaging signs of bipartite patella and to avoid the fault in medicolegal expertise testimony, three cases of bipartite patella were analyzed in combination of literature review, and the possible causes, histological changes, imaging signs, and clinical manifestation of bipartite patella were also discussed. The three cases concerned were all adults, two male and one female. They all felt pain after knee joint injury and were diagnosed as patellar fracture in medical institutions. Two cases were appraised on the degree of injury and one was on the degree of disability. According to Saupe＇s grouping, two cases were group Ⅲ, and one was group Ⅱ and Ⅲ. In the practice of medicolegal expertise testimony, recognizing imaging signs of bipartite patella could provide more rigorous and objective conclusion.