骨科英文书籍精读（333）｜髌骨脱位（3）
我们正在精读国外经典骨科书籍《Apley’s System of Orthopaedics and Fractures》，想要对于骨科英文形成系统认识，为以后无障碍阅读英文文献打下基础，请持续关注。
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Imaging
Anteroposterior, lateral and tangential ('skyline’) x-ray views are needed. In an unreduced dislocation, the patella is seen to be laterally displaced and tilted or rotated. In 5 percent of cases there is an associated osteochondral fracture.
MRI may reveal a soft-tissue lesion (e.g. disruption of the medial patellofemoral ligament) as well as articular cartilage and/or bone damage.
Treatment
In most cases the patella can be pushed back into place without much difficulty and anaesthesia is not always necessary; the exception is an intra-articular (intercondylar) dislocation, which may need open reduction.
If there are no signs of soft tissue rupture – i.e. there is minimal swelling, no bruising and little tenderness – cast splintage alone will usually suffice. The knee is aspirated and then immobilized in almost full extension; a small pad along the lateral edge of the patella may help to keep the medial soft tissues relaxed. The cast is retained for 2 or 3 weeks and the patient then undergoes a long period (2–3 months) of quadriceps strengthening exercises.
The same approach has been advocated for more severe forms of dislocation. However, if there is much bruising, swelling and tenderness medially, the patellofemoral ligaments and retinacular tissues are probably torn and immediate operative repair will reduce the likelihood of later recurrent dislocation.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
medial patellofemoral ligament内侧髌股韧带
pad /pæd/n. 衬垫；便签簿；平板电脑；
有道翻译（仅供参考，建议自己翻译）：
影像
需要前后、横向和切向（“天际线”）x射线视图。在未复位脱位中，可以看到髌骨侧向移位、倾斜或旋转。5%的病例伴有骨软骨骨折。
MRI可显示软组织损伤（如髌股内侧韧带断裂）以及关节软骨和/或骨损伤。
治疗
在大多数情况下，髌骨可以很容易地推回原位，并不总是需要麻醉；关节内（髁间）脱位除外，可能需要切开复位。
如果没有软组织破裂的迹象-即有轻微的肿胀，没有瘀伤和轻微的压痛-单用石膏夹板通常就足够了。膝盖被抽吸，然后几乎完全伸展固定；沿着髌骨外侧边缘的一个小垫子可能有助于保持内侧软组织放松。铸型保留2-3周，然后患者进行长时间（2-3个月）的股四头肌强化训练。
对于更严重的错位形式，也提倡同样的方法。然而，如果内侧有许多瘀伤、肿胀和压痛，则髌股韧带和支持带组织可能撕裂，立即手术修复可降低后期复发性脱位的可能性。