Starke W
Unfallchirurg. 1989 Jan;92(1):6-10.
In comparison with injuries sustained in adult life, ruptures of the fibular ligaments before growth is complete are more frequently characterized by chondral, osseous and periosteal loosening, which was seen up to the 14th year of age in about 50% of our own population of 129 patients up to the 16th year of life. The average age of patients with osseous and chondral lesions was clearly lower than that of those with periosteal injuries, which was lower than that of patients with inter-ligament ruptures. Accidents at school and during school sports classes were the most frequent cause, being involved in more than 50% of cases; of the various kinds of sport engaged in soccer was the most frequent cause, accounting for 28.8% of all cases. Manual examination of ligamentous stability compared with the opposite side by roentgenoscopy without anaesthesia has proved its worth for a definite diagnosis in fresh injuries. In all cases of evident ligamentous instability operative treatment was indicated, with subsequent immobilization with a plaster cast for 6 weeks. Stable healing of the ligament and a good functional result in all cases as well as a very low rate of complications vindicate this management. Conservative therapy, especially in the age group with normally high activity levels, is now considered correct only in exceptional cases or when operative treatment is refused.
与成人期受伤相比,在生长发育未完成前发生的腓骨韧带断裂,更常见的特征是软骨、骨质和骨膜松动,在我们的129例16岁以下患者中,约50%在14岁前出现这种情况。伴有骨质和软骨损伤患者的平均年龄明显低于伴有骨膜损伤的患者,而后者又低于伴有韧带间断裂的患者。学校及学校体育课期间发生的意外是最常见的原因,超过50%的病例与之相关;在各类运动中,足球是最常见的致伤原因,占所有病例的28.8%。通过在无麻醉情况下经X线透视与对侧对比进行韧带稳定性的手法检查,已证明其在新鲜损伤明确诊断中的价值。在所有明显韧带不稳定的病例中,均需进行手术治疗,随后用石膏固定6周。韧带顺利愈合,所有病例功能恢复良好,且并发症发生率极低,证明了这种治疗方法的合理性。保守治疗,特别是在通常活动水平较高的年龄组中,现在仅在特殊情况下或患者拒绝手术治疗时才被认为是正确的。