关节镜下治疗儿童交叉韧带损伤.ppt

儿童前交叉韧带损伤重建,广西中医药大学第一附属医院骨关节创伤手外科国家卫生部骨科内镜与微创医学广西培训基地席智杰,CaineD,MaffulliN,CaineC.Epidemiologyofinjuryinchildandadolescentsports:injuryrates,riskfactors,andprevention.ClinSportsMed.2019;27:19-50.,流行病学,ACL损伤是活跃儿童最严重、发病率最高的运动相关性损伤之一，发病率在上升,5-18岁高发，占膝关节损伤的31%女:男=2.8青春期前部分撕裂、止点撕脱青春期后完全撕裂,1K.G.Shea,R.Pfeiffer,H.W.Jo,M.Curtin,andP.J.Apel,“Anteriorcruciateligamentinjuryinpediatricandadolescentsoccerplayers:ananalysisofinsurancedata,”JournalofPediatricOrthopaedics,vol.24,no.6,pp.623628,2019.2J.S.Prince,T.Laor,andJ.A.Bean,“MRIofanteriorcruciateligamentinjuriesandassociatedfindingsinthepediatricknee:changeswithskeletalmaturation,”AmericanJournalofRoentgenology,vol.185,no.3,pp.756762,2019.,儿童的ACL损伤的特殊性,骨骺给治疗带来很多障碍,膝关节骨骺:下肢2/3长度骨骺闭合时间:男:6-18，女:14-16,合并伤较少,10岁以下很少有半月板和关节软骨的损伤早期OA的可能性小,HAVARDMOKSNES,LARSENGEBRETSEN,MAYARNARISBERG.ManagementofAnteriorCruciateLigamentInjuriesinSkeletallyImmatureIndividuals.journaloforthopaedic&sportsphysicaltherapy.2019,42(3):172-183.,诊断困难,儿童的ACL较成人松弛儿童的MRI检查特异性和敏感性下降,自愈能力强治疗方案的特殊性,JoshuaL.HudgensandDianeL.Dahm.TreatmentofAnteriorCruciateLigamentInjuryinSkeletallyImmaturePatientJ.sHindawiPublishingCorporationInternationalJournalofPediatricsVolume2019,ArticleID932702,6pagesdoi:10.1155/2019/932702,VS,P.VavkenandM.M.Murray,“Treatinganteriorcruciateligamenttearsinskeletallyimmaturepatients,”Arthroscopy,vol.27,no.5,pp.704716,2019.,VS,手术方法,HAVARDMOKSNES,LARSENGEBRETSEN,MAYARNARISBERG.ManagementofAnteriorCruciateLigamentInjuriesinSkeletallyImmatureIndividuals.journaloforthopaedic&sportsphysicaltherapy.2019,42(3):172-183.,非解剖重建：骨-髌腱-骨重建,非解剖重建：髂胫束重建,非解剖重建：髂胫束重建,非解剖重建：髂胫束重建,如何进行儿童的解剖重建？,解剖重建内口解剖,MRI-,关节镜下所见，ACL实质部偏下方断裂。,如此严重的损伤必定有合并伤！,外侧半月板后角瓣状裂,利用ACL瞄准器定位股骨隧道内口及外口,通过瞄准器钻入导针,利用ACL瞄准器定位胫骨隧道内口及外口。,ACL内口比较重要。,残根用缝合钩缝合，用PDS-保残,电视透视避开骨骺线,电视透视避开骨骺线,透视证实后钻空心钻头。,穿入钢丝准备引线,将半腱肌及股薄肌编织。,将半腱肌及股