Schneider F, Sperl M, Steinwender G, Kraus T
Abteilung für Kinderorthopädie, Universitätsklinik für Kinderchirurgie, Medizinische Universität Graz, Auenbruggerplatz 34, 8036, Graz, Österreich,
Orthopade. 2014 Apr;43(4):393-401: quiz 402-3. doi: 10.1007/s00132-014-2290-6.
Patella dislocations are the most common knee injuries causing hemarthrosis in children. Flake fractures represent the main complication of these injuries and require fixation. First time dislocations are treated conservatively. Recurrent dislocations are managed operatively. Precise analysis of the underlying dispositional and pathological factors is important to determine the appropriate operative procedure. To protect the growth plate, special techniques are required. Tibial spine fractures are bony avulsions of the anterior cruciate ligament (ACL). Management includes closed reduction in hyperextension and immobilization in a knee cast. Tibial spine fractures which cannot be reduced require operative treatment using either arthroscopic or open reduction and stabilization without injuring the growth plate. Intraligamentous ACL injuries are increasingly observed in children and adolescents. The risk of meniscus tears or chondral damage is high in these injuries. In case of persistent ACL instability, early reconstruction is recommended. Various techniques have been described; however, there is no consensus regarding the most favorable technique. The attending physician must be familiar with different ACL reconstruction techniques and with the anatomy of the growth plate. Meniscus tears require early suturing. Healing rates are good in children.
髌骨脱位是儿童膝关节损伤中导致关节积血最常见的原因。片状骨折是这些损伤的主要并发症，需要进行固定。首次脱位采用保守治疗。复发性脱位则进行手术治疗。准确分析潜在的体质和病理因素对于确定合适的手术方法很重要。为保护生长板，需要采用特殊技术。胫骨棘骨折是前交叉韧带（ACL）的撕脱性骨折。治疗包括在膝关节过伸位进行闭合复位并使用膝关节石膏固定。无法复位的胫骨棘骨折需要采用关节镜或切开复位并稳定骨折块的手术治疗，同时避免损伤生长板。儿童和青少年中韧带内ACL损伤越来越常见。这些损伤中半月板撕裂或软骨损伤的风险很高。如果ACL持续不稳定，建议早期重建。已经描述了各种技术；然而，关于最有利的技术尚无共识。主治医生必须熟悉不同的ACL重建技术以及生长板的解剖结构。半月板撕裂需要早期缝合。儿童的愈合率良好。
