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NEJM：髌骨骨折伴袖状撕脱伤-案例报道

2016-12-15 xing.T MedSci原创

髌骨骨折伴袖状撕脱伤
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这种骨折几乎只发生于儿童，并且是发生在髌骨完全骨化之前，通常发生在外部强大的压力负荷作用于弯曲的膝关节时；大部分骨折主要涉及髌骨下极。骨折在X光片上是很难看到的，尤其是当撕脱骨碎片较为细小或不存在时。

患者为一名9岁女孩，因在蹦床上跳跃右膝弯曲落地后出现膝关节疼痛和无法伸展右腿而就诊。

体格检查发现髌骨向上移位（如图A所示），通过X光片发现髌骨下极存在骨折（如图B所示；箭头表示断裂的两点）。当“袖子”一样的骨膜被拉出，髌骨就会发生髌骨骨折伴袖状撕脱伤。
 


这种骨折几乎只发生于儿童，并且是发生在髌骨完全骨化之前，通常发生在外部强大的压力负荷作用于弯曲的膝关节时；大部分骨折主要涉及髌骨下极。骨折在X光片上是很难看到的，尤其是当撕脱骨碎片较为细小或不存在时。

这个病人，在受伤当天进行开放复位和内固定时髌骨骨折伴袖状撕脱伤的诊断被证实。病人在受伤后2个月内能够恢复，并且进行全部的活动。

原始出处：


Rachel A. Lindor,et al.Patellar Fracture with Sleeve Avulsion. N Engl J Med .December 15, 2016.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1924670, encodeId=2f3019246e028, content=<a href='/topic/show?id=6cec10209670' target=_blank style='color:#2F92EE;'>#髌骨骨折#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102096, encryptionId=6cec10209670, topicName=髌骨骨折)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f49517, createdName=xinmeili, createdTime=Thu Jul 13 19:28:00 CST 2017, time=2017-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165759, encodeId=c7ca165e59d4, content=为什么这个可以发新英格兰, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cf2f1692094, createdName=Nickyoungyt, createdTime=Mon Dec 26 10:38:08 CST 2016, time=2016-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1363568, encodeId=713f13635681f, content=<a href='/topic/show?id=d23f10209183' target=_blank style='color:#2F92EE;'>#髌骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102091, encryptionId=d23f10209183, topicName=髌骨)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dab8203, createdName=zsyan, createdTime=Fri Dec 16 22:28:00 CST 2016, time=2016-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163289, encodeId=5cb1163289be, content=文章不错，值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Dec 16 14:03:07 CST 2016, time=2016-12-16, status=1, ipAttribution=)]
    2017-07-13 xinmeili

    #髌骨骨折#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1924670, encodeId=2f3019246e028, content=<a href='/topic/show?id=6cec10209670' target=_blank style='color:#2F92EE;'>#髌骨骨折#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102096, encryptionId=6cec10209670, topicName=髌骨骨折)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f49517, createdName=xinmeili, createdTime=Thu Jul 13 19:28:00 CST 2017, time=2017-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165759, encodeId=c7ca165e59d4, content=为什么这个可以发新英格兰, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cf2f1692094, createdName=Nickyoungyt, createdTime=Mon Dec 26 10:38:08 CST 2016, time=2016-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1363568, encodeId=713f13635681f, content=<a href='/topic/show?id=d23f10209183' target=_blank style='color:#2F92EE;'>#髌骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102091, encryptionId=d23f10209183, topicName=髌骨)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dab8203, createdName=zsyan, createdTime=Fri Dec 16 22:28:00 CST 2016, time=2016-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163289, encodeId=5cb1163289be, content=文章不错，值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Dec 16 14:03:07 CST 2016, time=2016-12-16, status=1, ipAttribution=)]
    2016-12-26 Nickyoungyt

    为什么这个可以发新英格兰

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1924670, encodeId=2f3019246e028, content=<a href='/topic/show?id=6cec10209670' target=_blank style='color:#2F92EE;'>#髌骨骨折#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102096, encryptionId=6cec10209670, topicName=髌骨骨折)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f49517, createdName=xinmeili, createdTime=Thu Jul 13 19:28:00 CST 2017, time=2017-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165759, encodeId=c7ca165e59d4, content=为什么这个可以发新英格兰, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cf2f1692094, createdName=Nickyoungyt, createdTime=Mon Dec 26 10:38:08 CST 2016, time=2016-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1363568, encodeId=713f13635681f, content=<a href='/topic/show?id=d23f10209183' target=_blank style='color:#2F92EE;'>#髌骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102091, encryptionId=d23f10209183, topicName=髌骨)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dab8203, createdName=zsyan, createdTime=Fri Dec 16 22:28:00 CST 2016, time=2016-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163289, encodeId=5cb1163289be, content=文章不错，值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Dec 16 14:03:07 CST 2016, time=2016-12-16, status=1, ipAttribution=)]
    2016-12-16 zsyan

    #髌骨#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1924670, encodeId=2f3019246e028, content=<a href='/topic/show?id=6cec10209670' target=_blank style='color:#2F92EE;'>#髌骨骨折#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102096, encryptionId=6cec10209670, topicName=髌骨骨折)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f49517, createdName=xinmeili, createdTime=Thu Jul 13 19:28:00 CST 2017, time=2017-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165759, encodeId=c7ca165e59d4, content=为什么这个可以发新英格兰, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cf2f1692094, createdName=Nickyoungyt, createdTime=Mon Dec 26 10:38:08 CST 2016, time=2016-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1363568, encodeId=713f13635681f, content=<a href='/topic/show?id=d23f10209183' target=_blank style='color:#2F92EE;'>#髌骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102091, encryptionId=d23f10209183, topicName=髌骨)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dab8203, createdName=zsyan, createdTime=Fri Dec 16 22:28:00 CST 2016, time=2016-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163289, encodeId=5cb1163289be, content=文章不错，值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Dec 16 14:03:07 CST 2016, time=2016-12-16, status=1, ipAttribution=)]
    2016-12-16 1e10c84am36(暂无匿称)

    文章不错，值得学习

    0

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