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年轻运动员慢性膝痛或膝损伤的处理方法

Author
Albert C Hergenroeder, MD
Section Editors
Joseph Chorley, MD
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH
Translators
李凯, 副主任医师

引言

年轻运动员的慢性膝痛可能是由先前损伤恢复不充分或重复性活动引起的。慢性膝痛也可由与体育活动无关的疾病[如骨肿瘤、感染、关节炎、股骨头骨骺滑脱(slipped capital femoral epiphysis, SCFE)、Legg-Calvé-Perthes病]引起；在鉴别诊断和评估中必须考虑这些疾病[1]。(参见相应专题)。

对慢性膝痛的处理方法与急性膝痛类似。虽然患者通常疼痛较轻，但评估单个结构使用的体格检查技术相同。其他的技术和手法用于检测仅慢性发生的问题[例如，Ober试验用于检查髂胫束(iliotibial band, ITB)综合征，Thomas试验用于检查股四头肌柔韧性]。

对年轻运动员慢性膝痛的处理方法将总结在此。膝痛的原因和治疗，以及对年轻运动员急性膝痛的处理方法将单独讨论。 (参见“对年轻运动员急性膝关节疼痛或损伤的认识”)

病史

评估年轻运动员的膝痛或膝损伤时，确定下列几点很重要[2,3]：

  • 主诉是急性还是慢性。急性主诉的评估将单独讨论。 (参见“对年轻运动员急性膝关节疼痛或损伤的认识”)
  • 损伤的机制。例如，它是由特定事件触发，还是在重复性活动后产生的？如果涉及某一特定事件，是否有录像带，或有能够描述发生经过的目击者？如果涉及重复性活动，这种活动是什么？活动的训练要求是什么？患者是否运用适当的设备和运动技术？
  • 疼痛的位置。
  • 是否有机械性症状(如交锁、砰砰声或卡锁)。
  • 患者是否有不稳定性感觉(即“打软腿”)或功能限制。
  • 既往膝损伤的任何病史。如果有，是如何评估和治疗的？

                      

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-02.
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