什么是膝盖骨骨折?

A kneecap (patella) fracture is a break of the bone located on the front of the knee joint. 髌骨是 籽骨 bone: a round bone embedded in a tendon that shields and protects a joint. 在髌骨的情况下, ligaments attach it to both the thigh muscles (quadriceps) and the shinbone (tibia).

在某些情况下, kneecap fractures can be accompanied by injuries to knee tendons and ligaments due to the initial impact to the knee.

膝盖骨骨折的类型

The type of patella fracture depends on the mechanism and severity of the injury. 它会受到你的体重和整体健康状况的影响.

移位和非移位膝盖骨骨折

• Nondisplaced kneecap fractures occur when the patella is broken but hasn’t moved out of place.
• In displaced patella fractures, the patella is broken and the pieces of bone have moved out of place.

闭合性和开放性膝盖骨骨折

• A kneecap fracture is considered closed if the broken pieces of patella do not pierce the skin.
• In open kneecap fractures, the bones stick out of the skin, creating a complex wound.

粉碎性、非粉碎性和发际膝盖骨骨折

• A comminuted patella fracture is one in which the bone is shattered into three or more pieces.
• In a noncomminuted patella fracture, the kneecap is broken in two pieces.
• A hairline kneecap fracture is a simple crack in the bone (the patella is still in one piece). Hairline fractures are also known as stress fractures, and are rare in the kneecap. They can occur in athletes, such as marathon runners, and may be due to overuse. 髌骨应力性骨折可能很难在x光片上看到. The main symptom is pain in the front of the knee that gets worse over time.

髌骨套筒骨折

髌骨袖损伤可影响儿童, most commonly between ages 8 and 12 when the bony portion of the knee is still forming. The injury happens when the bony part of the patella gets pulled out of its sleeve of cartilage. 骨头没有断, 所以严格来说这不是骨折, 尽管它们的处理方式相似.

是什么导致了膝盖骨骨折?

Patella fractures are injuries often associated with a blow to the knee. 常见原因包括:

• Falling directly on the knee, especially on a hard surface such as concrete
• 膝盖可能被球、球棒或棍棒直接击中的运动
• 膝盖撞到仪表板的车祸
• 枪伤
• Sudden contractions (pulling) of the quadriceps muscle that causes the tendon to pull on the kneecap and break it apart

膝盖骨骨折症状

髌骨骨折的症状包括:

• 膝盖骨周围或膝盖疼痛
• 瘀伤
• Swelling, which can be severe, even with relatively minor kneecap fractures
• Inability to bend or straighten the knee or to hold the leg out straight
• 不能承受重量、站立或行走
• 膝关节畸形，尤指严重骨折
• Bone protruding from the skin of the knee in the case of an open patellar fracture

如果你在膝盖或腿部受伤后出现这些症状, 打电话给你的医生或去紧急护理诊所检查.

髌骨骨折诊断

Your doctor may use some of the following techniques to determine if you have fractured your patella:

• 病史:医生会问你最近有没有外伤, 比如运动损伤, 汽车事故或坠落.
• Physical examination: The doctor will examine the knee and check for deformity that can be felt through the skin such as gaps or edges of bone.
• 医生可能会在膝盖骨上轻轻压一下, and may bend or straighten the leg to see if those actions cause or increase pain or reveal a deformity.
• X-rays help the doctor identify a fracture and see if there are fragments.

膝盖骨骨折的治疗

Treatment for patella fracture varies depending on how severe the break is, 还有你的年龄, 健康和其他因素.

紧急护理

髌骨骨折会导致关节大量出血. Emergency treatment may include draining blood and fluid from the joint to reduce swelling and pain and to make it easier to diagnose the problem.

非手术治疗

非手术治疗 is typically recommended for more stable patellar fractures or less severe breaks and may include:

• 在骨头愈合时用来固定腿的石膏或夹板
• 减轻负重的防止或减轻负重的
• Pain medications (opioid pain medication may be appropriate for the first few days after a severe kneecap fracture, 其次是非阿片类药物选择)
• Physical therapy and walking aids to help you regain strength and independence.

膝盖骨修复手术

Surgical treatment is typically recommended for more severe kneecap fractures. 手术修复可以:

• 使用螺丝、大头针和金属丝将较大的髌骨片固定在一起
• 移除那些太小而无法重新连接的骨头碎片. 非常严重的粉碎性骨折, 可能需要切除部分或全部膝盖骨, but the surgeon will attempt to preserve and reattach as much of the kneecap as possible.
• Address damage to the patellar ligament and other structures in the knee joint associated with the fracture (for example, in the case of an open fracture where bone pieces have damaged the skin and soft tissue)

髌骨骨折后的恢复和并发症

膝盖是一个承受重量的复杂关节. Even after treatment, you may experience continued pain and reduced range of motion. Post-traumatic arthritis (thinning of cartilage due to trauma) of the knee is a common complication of patella fractures and other knee injuries.

用石膏或夹板固定几周或几个月后, 腿部可能出现肌肉萎缩. Physical therapy can help minimize atrophy and prevent it from becoming permanent, 以及恢复肌肉力量, 灵活性和活动范围. Physical therapy and occupational therapy may also be recommended if you had surgery to repair the kneecap.

取决于你的年龄和健康状况, 膝盖骨骨折需要三到六个月的时间才能恢复, 但非常严重的髌骨损伤可能需要更长的时间.

有一段时间, 你可能会被建议避免爬楼梯, 蹲, 跪着或其他使膝关节紧张的活动. 在大多数情况下, you should still be able to walk with a fractured kneecap while the knee is immobilized and healing. Your care team will recommend exercises and weight-bearing restrictions appropriate for each stage of recovery.

Persistent pain or severe post-traumatic osteoarthritis in the knee can call for continued reassessment and further surgery, 包括 膝关节置换.