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患者男,12岁。因跳高弹跳时忽听到一撕裂声即感左膝剧烈疼痛、随之屈曲着地、活动受限半天入院。查体:左膝重度肿胀、皮肤瘀斑、压痛、浮髌试验阳性,髌骨下缘可扪及一异常间隙,膝关节伸直受限。X线片示左膝关节间隙增宽,髌骨下极有一小骨片撕脱,分离3cm。诊断为左髌骨下极撕脱骨折。于次日在硬膜外麻醉下行切开复位内固定术。术中见浅筋膜瘀血明显,髌前腱膜自髌骨上缘处广泛撕脱,髌腱扩张部关节囊部分撕裂,髌骨中下部边缘有5块软骨骨块,下极有一小撕脱骨片连同髌腱向下移位约3cm。清除关节腔积血,探查前后交叉韧带、半月板正常。在髌骨下部横形钻孔,将下极骨片及髌腱用粗丝线固定。修补关节囊、髌腱扩张部及髌前腱膜。膝屈30°石膏托固定。6周后去石膏托功能锻炼,随访1年,左膝功能正常。
Patient male, 12 years old. High jump bounce suddenly heard a tear that left the knee severe pain, followed by flexion to the ground, limited mobility half a day admitted to hospital. Examination: severe left knee swelling, skin ecchymosis, tenderness, floating patella test was positive, palpable patella lower edge of an abnormal gap, knee extension limited. X-ray showed a widening of the left knee joint gap, a very small patellar bone avulsion, separation 3cm. Diagnosis of left patella avulsion fracture. The next day in the epidural anesthesia underwent open reduction and internal fixation. Surgery see shallow fascia bleeding, patellar aponeurosis from the upper edge of the patella extensive avulsion, patellar tendon dilatation of the joint capsule partial tear, the middle of the lower edge of the patella 5 cartilage bone, the bottom of a small avulsion Bone patellar tendon bone along with displacement down about 3cm. Remove joint hemorrhage, explore the anterior cruciate ligament, meniscus normal. Horizontal drilling in the lower patella, the next bone pieces and patellar tendon with thick thread fixation. Repair joint capsule, patellar tendon dilatation and anterior patellar tendon. Knee flexion 30 ° plaster fixed. After 6 weeks to go plaster exercise, follow-up 1 year, left knee function is normal.