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頁籤選單縮合
題 名 | Management of Patellofemoral Arthrosis in Middle-Aged Patients=中年人膝蓋骨與股骨關節炎的治療 |
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作 者 | 王清貞; | 書刊名 | 長庚醫學 |
卷 期 | 24:11 2001.11[民90.11] |
頁 次 | 頁672-680 |
分類號 | 416.61 |
關鍵詞 | 治療; 膝蓋骨與股骨; 關節炎; 中年的; Management; Patellofemoral; Arthrosis; Middle-aged; |
語 文 | 英文(English) |
中文摘要 | 膝蓋骨與股骨關節炎是引起中年人膝蓋疼痛最常見的原因之一,這種疾病往往與膝蓋骨與股骨之間的排列不整有關。正確的診斷依據病史,臨床檢查以及X光等等。起初的治療通常採保守療法,這包括服用抗發炎藥,物理治療,護膝及股四頭肌強化運動等。若病情持續六個月保守療法無效時則考慮施以外科手術。 側韌帶放鬆與近端韌帶重整只能使用在少數選擇性的病患。遠端脛骨粗隆轉移術是最有效的治療方式,但是脛骨粗隆的轉換的角度要非常精準,另加穩定的內固定以便術後的復健運動;脛骨粗隆的轉移程度因人而異。由膝蓋骨與股骨關節排列不整的程度來決定轉移的程度及方向。在沒有明顯的排列不整的情況之下,我們建議脛骨粗隆向前移動20 mm;有中度的膝蓋骨與股骨排列不良時,我們建議脛骨粗隆向前移15 mm;向內移5-10 mm,在嚴重的排列不良情況之下,脛骨粗隆應向前移10 mm,向內移15 mm。 三個關節面切骨術使用於當臏骨有下移的病變時。臏骨股骨關節成形術僅用於選擇性的病患。而全人工膝關節置換術則適用於兩個或三個關節面的膝關節炎。 |
英文摘要 | Patellofemoral arthrosis is one of the most common causes of knee pain in middle-aged patients, and is often associated with patellofemoral malalignment. A correct diagnosis is established by history taking and physical and radiographic examinations of the knee. The initial treatment of choice is conservative treatment, which includes anti-inflammatory drugs, use of a knee brace, quadriceps-strengthening exercises, physical therapy, and modification of activity. Surgery is indicated when patients fail to improve after at least 6 months of conservative treatment and are functionally disabled. Lateral retinacular release and proximal realignment are performed only in selected cases. Distal realignment by anteromedial transfer of the tibial tubercle is the most effective method for treating patients with patellofemoral arthrosis. The magnitude of anteromedial transfer of the tibial tubercle must be individualized, and rigid internal fixation enables immediate postoperative rehabilitation. In knees with patellofemoral arthrosis with no malalignment, a 20-mm anterior displacement without medial transfer of the tibial tubercle is suggested. A 15-mm anterior displacement plus 5 to 10 mm of medial transfer of the tibial tubercle is recommended in knees with patellofemoral arthrosis and mild to moderate malalignment. In knees with severe malalignmemt, 15 mm of medial transfer and 10 mm of anterior displacement are recommended. A triple osteotomy is considered in knees with patellofemoral osteoarthrosis and patella baja. Patellofemoral resurfacing arthroplasty is only done in carefully selected patients. A patellectomy should be avoided if at all possible. Total knee arthroplasty is indicated in knees with bi- or tricompartmental osteoarthritis. |
本系統中英文摘要資訊取自各篇刊載內容。