关节镜下治疗儿童交叉韧带损伤课件

儿童前交叉韧带损伤重建国家卫生部骨科内镜与微创医学广西培训基地CaineD,MaffulliN,CaineC.Epidemiologyofinjuryinchildandadolescentsports:injuryrates,riskfactors,andprevention.ClinSportsMed.2008;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[1]K.G.Shea,R.Pfeiffer,H.W.Jo,M.Curtin,andP.J.Apel,“Anteriorcruciateligamentinjuryinpediatricandadolescentsoccerplayers:ananalysisofinsurancedata,”JournalofPediatricOrthopaedics,vol.24,no.6,pp.623–628,2004.[2]J.S.Prince,T.Laor,andJ.A.Bean,“MRIofanteriorcruciateligamentinjuriesandassociatedfindingsinthepediatricknee:changeswithskeletalmaturation,”AmericanJournalofRoentgenology,vol.185,no.3,pp.756–762,2005.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.2012,42(3):172-183.自愈能力强——治疗方案的特殊性JoshuaL.HudgensandDianeL.Dahm.TreatmentofAnteriorCruciateLigamentInjuryinSkeletallyImmaturePatient[J].sHindawiPublishingCorporationInternationalJournalofPediatricsVolume2012,ArticleID932702,6pagesdoi:10.1155/2012/932702VSP.VavkenandM.M.Murray,“Treatinganteriorcruciateligamenttearsinskeletallyimmaturepatients,”Arthroscopy,vol.27,no.5,pp.704–716,2011.VS手术方法HAVARDMOKSNES,LARSENGEBRETSEN,MAYARNARISBERG.ManagementofAnteriorCruciateLigamentInjuriesinSkeletallyImmatureIndividuals.journaloforthopaedic&sportsphysicaltherapy.2012,42(3):172-183.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：髂胫束重建解剖重建内口解剖MRI-关节镜下所见，ACL实质部偏下方断裂。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ACL内口比较重要。残根用缝合钩缝合，用PDS-Ⅱ保残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