關(guān)節(jié)鏡下治療兒童交叉韌帶損傷課件

兒童前交叉韌帶損傷重建國家衛(wèi)生部骨科內(nèi)鏡與微創(chuàng)醫(yī)學廣西培訓基地CaineD,MaffulliN,CaineC.Epidemiologyofinjuryinchildandadolescentsports:injuryrates,riskfactors,andprevention.ClinSportsMed.2008;27:19-50.流行病學ACL損傷是活躍兒童最嚴重、發(fā)病率最高的運動相關(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、止點撕脫青春期后——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.膝關(guān)節(jié)骨骺:下肢2/3長度骨骺閉合時間: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HAVARDMOKSNES,LARSENGEBRETSEN,MAYARNARISBERG.ManagementofAnteriorCruciateLigamentInjuriesinSkeletallyImmatureIndividuals.journaloforthopaedic&sportsphysicaltherapy.2012,42(3):172-183.自愈能力強——治療方案的特殊性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手術(shù)方法HAVARDMOKSNES,LARSENGEBRETSEN,MAYARNARISBERG.ManagementofAnteriorCruciateLigamentInjuriesinSkeletallyImmatureIndividuals.journaloforthopaedic&sportsphysicaltherapy.2012,42(3):172-183.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：髂脛束重建解剖重建內(nèi)口解剖MRI-關(guān)節(jié)鏡下所見，ACL實質(zhì)部偏下方斷裂。外側(cè)半月板后角瓣狀裂利用ACL瞄準器定位股骨隧道內(nèi)口及外口通過瞄準器鉆入導針ACL內(nèi)口比較重要。殘根用縫合鉤縫合，用PDS-Ⅱ保殘透視證實后鉆空心鉆頭。穿入鋼絲準備引線將半腱肌及股薄肌編織。將半腱肌