1、兒童前交叉韌帶損傷重建,廣西中醫(yī)藥大學(xué)第一附屬醫(yī)院骨關(guān)節(jié)創(chuàng)傷手外科 國(guó)家衛(wèi)生部骨科內(nèi)鏡與微創(chuàng)醫(yī)學(xué)廣西培訓(xùn)基地 席智杰,Caine D, Maffulli N, Caine C. Epidemiology of injury in child and adolescent sports: injury rates, risk factors, and prevention. Clin Sports Med. 2008;27:19-50.,流行病學(xué),ACL損傷是活躍兒童最嚴(yán)重、發(fā)病率最高的運(yùn)動(dòng)相關(guān)性損傷之一，發(fā)病率在上升,5-18歲高發(fā)，占膝關(guān)節(jié)損傷的31% 女:男=2.8 青春期前部分撕裂、止點(diǎn)

2、撕脫 青春期后完全撕裂,1 K. G. Shea, R. Pfeiffer, H. W. Jo, M. Curtin, and P. J. Apel, “Anterior cruciate ligament injury in pediatric and adolescent soccer players: an analysis of insurance data,” Journal of Pediatric Orthopaedics, vol. 24, no. 6, pp. 623628, 2004. 2 J. S. Prince, T. Laor, and J. A. Bean, “MR

3、I of anterior cruciate ligament injuries and associated findings in the pediatric knee: changes with skeletal maturation,” American Journal of Roentgenology, vol. 185, no. 3, pp. 756762, 2005.,兒童的ACL損傷的特殊性,骨骺給治療帶來(lái)很多障礙,膝關(guān)節(jié)骨骺:下肢2/3長(zhǎng)度 骨骺閉合時(shí)間:男: 6-18 ，女: 14-16,合并傷較少,10歲以下很少有半月板和關(guān)節(jié)軟骨的損傷 早期OA的可能性小,HAVARD

4、MOKSNES, LARS ENGEBRETSEN,MAY ARNA RISBERG. Management of Anterior Cruciate Ligament Injuries in Skeletally Immature Individuals. journal of orthopaedic & sports physical therapy.2012 ,42 (3): 172-183.,診斷困難,兒童的ACL較成人松弛 兒童的MRI檢查特異性和敏感性下降,自愈能力強(qiáng)治療方案的特殊性,Joshua L. Hudgens and Diane L. Dahm. Treatment of

5、 Anterior Cruciate Ligament Injury in Skeletally Immature PatientJ.sHindawi Publishing Corporation International Journal of Pediatrics Volume 2012, Article ID 932702, 6 pages doi:10.1155/2012/932702,VS,P. Vavken and M. M. Murray, “Treating anterior cruciate ligament tears in skeletally immature pati

6、ents,” Arthroscopy, vol. 27, no. 5, pp. 704716, 2011.,VS,手術(shù)方法,HAVARD MOKSNES, LARS ENGEBRETSEN,MAY ARNA RISBERG. Management of Anterior Cruciate Ligament Injuries in Skeletally Immature Individuals. journal of orthopaedic & sports physical therapy.2012 ,42 (3): 172-183.,非解剖重建：骨-髕腱-骨重建,非解剖重建：髂脛束重建,非解剖重建：髂脛束重建,非解剖重建：髂脛束重建,如何進(jìn)行兒童的解剖重建？,解剖重建 內(nèi)口解剖,MRI-,關(guān)節(jié)鏡下所見(jiàn)，ACL實(shí)質(zhì)部偏下方斷裂。,如此嚴(yán)重的損傷必定有合并傷！,外側(cè)半月板后角瓣?duì)盍?利用ACL瞄準(zhǔn)器定位股骨隧道內(nèi)口及外口,通過(guò)瞄準(zhǔn)器鉆入導(dǎo)針,利用ACL瞄準(zhǔn)器定位脛骨隧道內(nèi)口及外口。,ACL內(nèi)口比較重要。,殘根用縫合鉤縫合，用PDS-保殘,電視透視避開(kāi)骨骺線,電視透視避開(kāi)骨骺線,透視證實(shí)后鉆空心鉆頭。,穿入鋼絲準(zhǔn)備引線,將半腱肌及股薄