アブストラクト
Title | 2 外傷性膝蓋骨脱臼に対する保存的治療 |
---|---|
Subtitle | Feature 膝蓋骨脱臼 これで不安なし! 膝蓋骨不安定症対策 [保存的治療] |
Authors | 増田裕也, 中川匠 |
Authors (kana) | |
Organization | 帝京大学医学部整形外科学講座准教授, 帝京大学医学部整形外科学講座教授 |
Journal | 整形外科サージカルテクニック |
Volume | 10 |
Number | 1 |
Page | 22-28 |
Year/Month | 2020 / |
Article | 報告 |
Publisher | メディカ出版 |
Abstract | 「はじめに」外傷性膝蓋骨脱臼は, 決して少ない疾患ではない. 膝蓋骨脱臼は膝の外傷のうち3%を占めるといわれており, 外傷後の膝関節血症を呈する疾患としては前十字靱帯損傷に次いで2番目に多いとされている. スポーツ中に受傷することが多く, その2/3は20歳以下の症例で起こる. したがって, 若い患者がスポーツ中に膝を痛めて来院し, 膝関節血症を呈しているような場合では, 前十字靱帯損傷を疑うのはもちろんではあるが, 膝蓋骨脱臼のことも念頭に入れて診察を行う必要がある. 外傷性の膝蓋骨脱臼に対する治療方法の選択はいまだに議論が尽きない. 大きく分けると保存的治療と手術療法に大別されるが, そのどちらの方法がよりよいかは明らかになっていない. 初回膝蓋骨脱臼後に保存的治療を行った際の再脱臼率は13〜52%程度とされているのに対し, 初回脱臼後に手術療法を行った際の再脱臼率は10〜30%程度とされており, 再脱臼率だけを見れば手術療法に分があるように見えるが, この差をもって全症例手術療法を行うという判断は妥当とはいえない. |
Practice | 臨床医学:外科系 |
Keywords |
- 全文ダウンロード: 従量制、基本料金制の方共に1,749円(税込) です。
参考文献
- 1) Harilainen A. et al. The significance of arthroscopy and examination under anaesthesia in the diagnosis of fresh injury haemarthrosis of the knee joint. Injury. 19(1), 1988, 21-4.
- 2) Stefancin JJ. et al. First-time traumatic patellar dislocation: a systematic review. Clin Orthop Relat Res. 455, 2007, 93-101.
- 3) Fithian DC. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 32(5), 2004, 1114-21.
- 4) Duthon VB. Acute traumatic patellar dislocation. Orthop Traumatol Surg Res. 101(1 Suppl), 2015, S59-67.
- 5) Longo UG. et al. Treatment of Primary Acute Patellar Dislocation: Systematic Review and Quantitative Synthesis of the Literature. Clin J Sport Med. 27(6), 2017, 511-23.
残りの21件を表示する
- 6) Rhee SJ. et al. Modern management of patellar instability. Int Orthop. 36(12), 2012, 2447-56.
- 7) Fuller JA. et al. Operative Versus Nonoperative Treatment After Acute Patellar Dislocation: Which Is More Effective at Reducing Recurrence in Adolescents? J Sport Rehabil. 27(6), 2018, 601-4.
- 8) Khan M. et al. Cochrane in CORR: Surgical Versus Nonsurgical Interventions for Treating Patellar Dislocation (Review). Clin Orthop Relat Res. 474(11), 2016, 2337-43.
- 9) Sillanpaa P. et al. Incidence and risk factors of acute traumatic primary patellar dislocation. Med Sci Sports Exerc. 40(4), 2008, 606-11.
- 10) Arendt EA. et al. Current concepts of lateral patella dislocation. Clin Sports Med. 21(3), 2002, 499-519.
- 11) Nikku R. et al. Operative treatment of primary patellar dislocation does not improve medium-term outcome: A 7-year follow-up report and risk analysis of 127 randomized patients. Acta Orthop. 76(5), 2005, 699-704.
- 12) Buchner M. et al. Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment. Clin J Sport Med. 15(2), 2005, 62-6.
- 13) Koh JL. et al. Patellar instability. Clin Sports Med. 33(3), 2014, 461-76.
- 14) Smith TO. et al. Clinical outcomes of rehabilitation for patients following lateral patellar dislocation: a systematic review. Physiotherapy. 96(4), 2010, 269-81.
- 15) Respizzi S. et al. First patellar dislocation: from conservative treatment to return to sport. Joints. 2(3), 2014, 141-5.
- 16) Hinton RY. et al. Acute and recurrent patellar instability in the young athlete. Orthop Clin North Am. 34(3), 2003, 385-96.
- 17) Maenpaa H. et al. Patellar dislocation. The long-term results of nonoperative management in 100 patients. Am J Sports Med. 25(2), 1997, 213-7.
- 18) Regalado G. et al. Six-year outcome after non-surgical versus surgical treatment of acute primary patellar dislocation in adolescents: a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc. 24(1), 2016, 6-11.
- 19) McConnell J. Rehabilitation and nonoperative treatment of patellar instability. Sports Med Arthrosc Rev. 15(2), 2007, 95-104.
- 20) Muhle C. et al. Effect of a patellar realignment brace on patients with patellar subluxation and dislocation. Evaluation with kinematic magnetic resonance imaging. Am J Sports Med. 27(3), 1999, 350-3.
- 21) Koskinen SK. et al. Effect of a patellar brace on patellofemoral relationships. Scand J Med. 1, 1991, 119-22.
- 22) Moller BN. et al. Dynamic knee brace in the treatment of patellofemoral disorders. Arch Orthop Trauma Surg. 104(6), 1986, 377-9.
- 23) Beasley LS. et al. Traumatic patellar dislocation in children and adolescents: treatment update and literature review. Curr Opin Pediatr. 16(1), 2004, 29-36.
- 24) Barton CJ. et al. Gluteal muscle activity and patellofemoral pain syndrome: a systematic review. Br J Sports Med. 47(4), 2013, 207-14.
- 25) Smith TO. et al. What activities do patients with patellar instability perceive makes their patella unstable? Knee. 18(5), 2011, 333-9.
- 26) Menetrey J. et al. Return to sport after patellar dislocation or following surgery for patellofemoral instability. Knee Surg Sports Traumatol Arthrosc. 22(10), 2014, 2320-6.