基于骨龄评估的经骺板自体腘绳肌肌腱重建治疗青少年前十字韧带损伤  

Transphyseal anterior cruciate ligament reconstruction in skeletally immature pubescent adolescents

作　　者：冯超[1] 黄林[1] 徐云峰[1] 李强 杨征[1] Feng Chao;Huang Lin;Xu Yunfeng;Li Qiang;Yang Zheng(Department of Pediatric Orthopedics,Bejing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院小儿骨科,北京100035

出　　处：《中华骨科杂志》2022年第16期1028-1036,共9页Chinese Journal of Orthopaedics

基　　金：北京市自然科学基金资助项目(L212041);北京市卫生健康委员会国际合作择优资助项目(国际合作处2021年19号)。

摘　　要：目的探讨经骺板自体半腱肌、股薄肌肌腱重建前十字韧带治疗青少年前十字韧带损伤的安全性及临床疗效。方法回顾2015年5月至2020年5月10例手术治疗的青少年前十字韧带损伤患者资料,男6例,年龄(14.2±1.4)岁(范围13~15岁),骨龄13~15岁;女4例,年龄(12.4±1.2)岁(范围11~13岁),骨龄11~13岁。病程(8.3±5.3)个月(范围3~48个月)。术前行左手及腕部X线片评估骨龄,术前及随访行双下肢全长X线片评估双下肢长度及力线,前抽屉试验、Lachman试验、KT-1000评估关节松弛度,Lysholm膝关节评分和Tegner膝关节运动评分评估膝关节功能。术中关节镜检查前十字韧带、内外侧半月板及关节软骨损伤状况。关节镜下行经股骨远端及胫骨近端双侧骺板单束前十字韧带重建术,移植物使用自体腘绳肌肌腱。术后佩带长腿伸膝位支具,术后1个月拆除支具,开始主动活动锻炼。手术前后的Lysholm膝关节评分和Tegner膝关节运动评分的比较采用t检验。结果10例关节镜检查提示前十字韧带均为完全断裂,合并内侧半月板损伤1例、外侧半月板损伤1例、内外侧半月板同时损伤1例。10例均获得随访,随访时间(3.2±2.3)年(范围2~5年)。1例术后1年出现韧带再损伤,前抽屉试验和Lachman试验阳性,余9例末次随访时Lysholm膝关节评分从术前(76.1±8.2)分提高至(95.8±3.5)分,与术前比较差异有统计学意义(t=6.43,P=0.024),Tegner膝关节运动评分从术前(4.3±0.9)分提高至(8.3±0.6)分,与术前比较差异有统计学意义(t=4.41,P=0.033)。9例中有1例前抽屉试验和Lachman试验弱阳性,KT-1000侧侧差值>3 mm,余8例前抽屉试验和Lachman试验均为阴性,KT-1000侧侧差值为(1.7±0.7)mm。10例关节活动度与健侧相比受限均<5°。站立位下肢全长X线片示双下肢未出现长度及角度畸形。结论对青少年(男骨龄≥13岁;女骨龄≥11岁)前十字韧带损伤患者采用股骨远端及胫骨近端双侧经Objective To evaluate the safety and clinical efficacy of transphyseal anterior cruciate ligament(ACL)reconstruction with hamstring autograft in skeletally immature pubescent adolescents.Methods Retrospectively reviewed 10 skeletally immature pubescent patients(10 knees)who underwent transphyseal ACL reconstruction with hamstring autograft between May 2015 and May 2020 in our center.Out of the 10 patients,6 were males aged 14.2±1.4 years(range,13-15 years)with bone age 13-15 years,4 were females aged 12.4±1.2 years(range,11-13 years)with bone age 11-13 years.The average duration from injury to surgery was 8.3±5.3 months(range,3-48 months).Before operation,left hand and wrist plain film were done to assess bone age.Before operation and at follow up,physical examination,KT-1000 measurements and functional outcome instruments(the Lysholm score,and the Tegner score)were done.Radiographs were performed for angular deformity and leg-length measurements.The surgery was conducted via arthroscopically assisted transphyseal reconstruction of the ACL with use of an autogenous quadrupled hamstring tendon graft and fixation devices that did not cross the physes.A protective knee brace was used for 1 month postoperatively.Comparison of Lysholm score and Tegner score before and after surgery was performed using t test.Results Arthroscopy confirmed ACL rupture in 10 knees.Concurrent meniscal surgery was performed in 3 knees.The follow-up duration was 3.2±2.3 years(range 2-5 years),one of 10 patients had ligament reinjury 1 year after surgery with positive anterior drawer test and Lachman test.As for the remaining 9 patients,the mean Lysholm knee score improved from preoperative 76.1±8.2 to 95.8±3.5,and the mean Tegner score improved from preoperative 4.3±0.9 to 8.3±0.6,both of the two outcomes had statistically significant difference(t=6.43,P=0.024;t=4.41,P=0.033).One patients was weakly positive for anterior drawer test and Lachman test,with KT-1000 side difference>3 mm,the remaining eight were negative for anterior dra

关 键 词：儿童 骨骼年龄测定 前交叉韧带损伤 前交叉韧带重建 

分 类 号：R726.8[医药卫生—儿科]