Woods G William, O'Connor Daniel P
Fondren Orthopedic Group LLP, University of Texas Health Science Center at Houston Medical School, Houston, Texas 77030, USA.
Am J Sports Med. 2004 Jan-Feb;32(1):201-10. doi: 10.1177/0363546503258868.
Treatment of anterior cruciate ligament rupture in adolescents with open physes is controversial.
Delaying reconstruction until the physes bridge will affect the rate of additional knee injuries.
Case control.
The physes group was 13 adolescents with open physes whose anterior cruciate ligament reconstructions were delayed until their physes bridged. Specific types of activity were absolutely restricted during the delay. The physes groups' rates of additional injuries, identified arthroscopically at reconstruction, were compared to rates among 116 skeletally mature adolescents. The comparison adolescents were stratified into four groups by interval from injury to reconstruction (<1 week, 1 to 6 weeks, 6 to 26 weeks, >26 weeks).
The additional injury rates in the physes and four comparison groups were 46%, 50%, 47%, 43%, and 69%, respectively. Severity of additional injury, mechanism of injury, and rate of additional surgical procedures were similar among the groups.
There was no evidence that intentionally delayed anterior cruciate ligament reconstruction increased the rate of additional knee injuries. Delayed reconstruction is a valid treatment option for adolescents with open physes at injury. Absolute activity restriction is key to decreasing the risk of additional knee injuries.
对于骨骺未闭的青少年前交叉韧带断裂的治疗存在争议。
将重建手术推迟至骨骺闭合会影响额外膝关节损伤的发生率。
病例对照研究。
骨骺组有13名骨骺未闭的青少年，他们的前交叉韧带重建手术被推迟至骨骺闭合。在推迟期间，特定类型的活动被严格限制。将骨骺组在重建时通过关节镜检查确定的额外损伤发生率与116名骨骼成熟青少年的发生率进行比较。将对照青少年按受伤至重建的时间间隔（<1周、1至6周、6至26周、>26周）分为四组。
骨骺组及四个对照组的额外损伤发生率分别为46%、50%、47%、43%和69%。各组之间额外损伤的严重程度、损伤机制及额外手术操作的发生率相似。
没有证据表明故意推迟前交叉韧带重建会增加额外膝关节损伤的发生率。对于受伤时骨骺未闭的青少年，推迟重建是一种有效的治疗选择。绝对限制活动是降低额外膝关节损伤风险的关键。
