膝关节表面置换术后髌韧带断裂1例

2018-03-07 佚名 中华关节外科杂志( 电子版)

患者女性,80岁

【一般资料】

患者女性,80岁

【主诉】

因“双膝疼痛3年,加重伴活动受限6月”就诊。

【现病史】

患者于就诊3年前无明显诱因下出现双膝部疼痛,休息后好转。就诊6月前双膝疼痛加重,尤其行走时疼痛明显,不能伸直,走路跛行。病程期间多次向关节腔内注射玻璃酸钠并自行口服药物“强骨粒”,病情无明显好转。

【体格检查】

血沉:58mm/h(魏氏法),余相关检验项无明显异常。查体:脊柱生理弯曲存在,各棘突区无叩击痛。双髋关节活动可,双侧股四头肌可见萎缩,双下肢皮肤感觉及末梢血运正常。内外侧关节间隙压痛(+)。余肢体无异常。

【辅助检查】

X线片示:双侧胫股间隙变窄,右膝外侧间隙消失,髁间凸变尖,软骨下硬化,股骨及胫骨边缘骨赘形成(图1)。



【治疗】

患者于入院后第3天在全麻下行双膝关节表面置换术,术中过程顺利,术毕安返病房。术后拍X线片示膝关节假体位置可(图2)。术后第1天患者于病床上行股四头肌等长锻炼,术后切口愈合可。因患者在术前长期病程中活动量少且体型肥胖,故股四头肌力量相对较弱,术前肌力:Ⅲ级。为防患者行走不稳,术后连续11d指导患者在病床上行股四头肌等长锻炼。术后第11天查体:双膝部略肿胀,左膝活动度屈曲60°,伸直0°,右膝活动度屈曲50°,伸直0°。患者于术后第12天在双人搀扶下尝试下床行走,行走约20m后返回病床,自诉于屈曲双膝关节、坐立于病床时突感双膝关节局部剧烈疼痛,打开双膝包扎辅料见:双侧膝部各有一个约200px横向开放性伤口,双侧伤口内可见关节假体(图3)。于急诊手术下探查见髌韧带中部马尾状断裂,修整皮缘,去除坏死组织及异物,修整韧带断端,缝合双侧髌韧带。术后双下肢上下石膏托予以局部制动。术后切口愈合可(图4),愈合等级:Ⅱ/甲。于髌韧带修复术后第20天给予可调式膝部矫形支具以固定双膝关节于伸直位,下床活动后,膝部无异常(图5)。髌韧带断裂修复术后6月随访,患者行走尚可(图6)。查体:双膝表面可见“十”形陈旧性瘢痕形成,左膝屈曲90°,伸直0°,右膝屈曲80°,伸直0°。内外侧关节间隙压痛(-)。


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    2018-08-31 yxch48
  2. [GetPortalCommentsPageByObjectIdResponse(id=1742473, encodeId=06661e4247348, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Fri Aug 31 17:23:00 CST 2018, time=2018-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=295188, encodeId=631f29518884, content=优质资源.共同学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sun Mar 11 12:55:48 CST 2018, time=2018-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507405, encodeId=4898150e4054d, content=<a href='/topic/show?id=16b7100010c7' target=_blank style='color:#2F92EE;'>#韧带#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100010, encryptionId=16b7100010c7, topicName=韧带)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9b19890064, createdName=juliusluan81, createdTime=Fri Mar 09 08:23:00 CST 2018, time=2018-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576600, encodeId=23c015e660018, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=054816326830, createdName=ms117281293605716, createdTime=Fri Mar 09 08:23:00 CST 2018, time=2018-03-09, status=1, ipAttribution=)]
    2018-03-11 虈亣靌

    优质资源.共同学习

    0

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