手术-髌骨环扎内固定术.docxVIP

1、原则 Surgical anatomy???手术解剖 The patella is the largest sesamoid bone in the human body. It is located within the extensor apparatus of the knee. Anatomical features include the proximal articular body, with an extraarticular anterior surface and a posterior articular surface, and the extraarticular distal pole. The rectus femoris and vastus intermedius muscles insert at the superior pole of the body and the vastus medialis and vastus lateralis muscles on either side. The patellar tendon originates from the inferior pole and inserts into the tibial tuberosity. The articular surface has the thickest layer of cartilage in the body, up to 5 mm, reflecting the very high resultant loads across the patello-femoral joint, rendering it susceptible to chondromalacia and degenerative joint disease. 髌骨是人体最大的籽骨，其位于膝关节伸膝装置的里面，解剖特征包括其正好位于关节的中部，有一个关节外面、一个关节内面和一个关节外下极。股直肌和股中间肌的止点经过髌骨的上表面；股内侧肌和股外侧肌经过其两侧。髌韧带起自髌骨下极止于胫骨结节。髌骨的内关节面有人体最厚的软骨层约有5mm，反映出髌股关节承受非常高的负荷，这正是容易发生髌骨软化及关节退变的原因。 History and examination??历史和检查 Patellar fractures comprise about 1% of all fractures and are mostly caused by direct trauma to the front of the knee, for example, a direct fall, or a blow onto the flexed knee. 髌骨骨折占全身骨折的1%，大部分由膝关节前方的直接暴力引起，例如，摔倒或打击在弯曲的膝部。 Bony avulsions of the adjacent tendons, or pure ruptures of the quadriceps and patellar tendons, are caused by indirect forces. 肌腱的撕脱骨折，或纯粹的股四头肌肌腱断裂和髌腱断裂，多由间接暴力引起。 Typical signs are swelling, tenderness and limited, or lost, function of the extensor mechanism. 骨折的典型征象是肿胀，压痛或活动受限，或有伸膝功能障碍。 Preservation of active knee extension does not rule out a patellar fracture if the auxiliary extensors of the knee - the medial and lateral parapatellar retinacula - are intact. 伸膝功能正常不能除外髌骨骨折，因为膝关节的附属韧带--内、外侧副韧带完整就可以伸膝。 If displacement is significant, it is possible to palpate a defect between the fragments, if present. The hemarthrosis is usually obvious. The examination must include assessment of the soft tissues, so as not to confuse with an injury to the prepatellar bur