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髌骨骨折

Author
Jim G Blount, MD, CAQSM
Section Editor
Patrice Eiff, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
张弢, 主任医师

引言

髌骨是最大的籽骨并发挥着重要作用。髌骨有助于膝关节伸展，能保护膝关节免受直接创伤，并且可为股骨远端的关节软骨提供营养[1]。髌骨骨折约占成人和儿童所有骨骼损伤的1%。

本专题将总结髌骨骨折。膝关节和下肢的其他损伤将单独讨论。 (参见“成人膝关节痛的一般评估”和“髌骨外侧脱位的识别和初始治疗”和“成人胫骨近端骨折”和“前交叉韧带损伤”和“膝关节半月板损伤”和“膝关节内侧副韧带损伤”)

临床解剖

髌骨及其周围组织 — 髌骨外形呈倒三角形(图片 1和图 1和图 2)。髌骨上极是股四头肌腱的止点部位，该肌腱由4条单独的股四头肌肌腱(股直肌、股内侧肌、股中间肌和股外侧肌)汇合而成。股四头肌腱包绕髌骨，在远端形成髌腱，止于胫骨粗隆。股四头肌施加于髌骨的力量(例如，从中等高度跌落后足着地时)可导致间接骨折，并且如果骨或肌腱完全断裂，则上端骨折碎片会向近侧缩回。

髌内侧支持带是股内侧肌肌腱膜的下延，其附着于髌骨上内侧缘，远端止于胫骨内侧髁。髌外侧支持带是股外侧肌肌腱膜的下延，其附着于髌骨上外侧缘，远端止于胫骨外侧髁。如果髌骨骨折后，内外侧支持带完好无损，则患者可能仍保留有主动伸膝的能力。

膝上、中、下动脉的吻合支是髌骨的主要血供(图片 2)。这些动脉分支通过髌骨中部和下极进入髌骨。因此，穿过髌骨中部的骨折会损害髌骨上极的血供并增加发生缺血性坏死的风险[1]。膝关节的解剖将单独更详细地讨论。 (参见“膝部体格检查”，关于‘解剖学’一节)

              

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Literature review current through: 2017-06 . | This topic last updated: 2016-11-21.
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