Vaquero Javier, Vidal Carlos, Cubillo Antonio
Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Clin Orthop Relat Res. 2005 Mar(432):97-106. doi: 10.1097/01.blo.0000156002.16750.8d.
Intra-articular knee injuries in children traditionally have been considered rarer than injuries in adults. Few studies establish the prevalence of knee injuries before skeletal maturity, but arthroscopic studies suggest an increased frequency of anterior cruciate ligament ruptures, meniscal tears, and osteochondral fractures. We report our experience with 15 anterior cruciate ligament injuries and 38 meniscus injuries treated between 1996 and 2001. The treatment of anterior cruciate ligament injuries is determined by Tanner's maturity criteria. In the three cases of Stage II injuries, surgery was delayed for up to 24 months in the 12 older patients, an immediate reconstruction was done using hamstring tendons in the three youngest patients, and patellar tendon treatment was done in the remaining cases. We had only one complication caused by the fracturing of the bone plug. The most frequent meniscus injuries were the traumatic tears (23 cases), 80% of which were peripheral and longitudinal. Whenever possible, the entire meniscus (suture in 4 cases) or the greater part of it (economic resection in 19 cases) should be conserved. Despite the satisfactory results, the average followup of the meniscal series (26.1 months) is too short a period to evaluate thoroughly the deterioration of the joint after a meniscectomy.
传统上认为儿童膝关节内损伤比成人少见。很少有研究确定骨骼成熟前膝关节损伤的患病率,但关节镜研究表明前交叉韧带断裂、半月板撕裂和骨软骨骨折的发生率有所增加。我们报告了1996年至2001年间治疗的15例前交叉韧带损伤和38例半月板损伤的经验。前交叉韧带损伤的治疗取决于坦纳成熟度标准。在3例II期损伤病例中,12名年龄较大的患者手术推迟长达24个月,3名最年轻的患者立即使用腘绳肌腱进行重建,其余病例采用髌腱治疗。我们仅有1例因骨栓骨折引起的并发症。最常见的半月板损伤是外伤性撕裂(23例),其中80%为周边和纵向撕裂。只要有可能,应保留整个半月板(4例缝合)或其大部分(19例经济性切除)。尽管结果令人满意,但半月板系列的平均随访时间(26.1个月)太短,无法彻底评估半月板切除术后关节的退变情况。