Buckley Patrick S, Dodson Christopher C
Rothman Institute at Thomas Jefferson University, 925 Chestnut St, Philadelphia, PA 19107 USA.
HSS J. 2018 Oct;14(3):302-306. doi: 10.1007/s11420-018-9620-x. Epub 2018 Jun 18.
Proximal hamstring tendon ruptures are rare in children and adolescents. The typical pediatric hamstring injury pattern involves an apophyseal avulsion fracture. We present the case of a 14-year-old male with a widely displaced ischial avulsion fracture and a bony fragment that was too small to allow for bony fixation. The patient presented with left-buttock pain and ecchymosis, as well as tenderness at the ischial tuberosity, following an injury sustained while running 2 weeks prior. Imaging demonstrated an avulsion of the proximal hamstrings with a 4-mm bony fragment, too small to allow for repair. The patient underwent primary repair using two 3-mm suture anchors. The bony fragment was not excised but incorporated into the repair. Although most proximal hamstring injuries in children and adolescents are treated non-operatively, operative treatment may confer a small but clinically important difference in rates of healing and return to play in adolescent athletes. This case demonstrates successful treatment of a proximal hamstring rupture with suture anchor fixation, which may be considered for pediatric and adolescent displaced avulsion fractures when the bony fragment is too small to allow for bony fixation.
近端腘绳肌腱断裂在儿童和青少年中较为罕见。典型的小儿腘绳肌损伤模式为骨骺撕脱骨折。我们报告一例14岁男性患者，其坐骨撕脱骨折移位广泛，且骨块过小无法进行骨固定。该患者在2周前跑步受伤后，出现左臀部疼痛、瘀斑以及坐骨结节压痛。影像学检查显示近端腘绳肌撕脱，伴有一个4毫米的骨块，太小无法进行修复。患者接受了使用两个3毫米缝合锚钉的一期修复。未切除骨块，而是将其纳入修复。尽管儿童和青少年的大多数近端腘绳肌损伤采用非手术治疗，但手术治疗可能在青少年运动员的愈合率和恢复运动方面带来微小但临床上重要的差异。本病例展示了使用缝合锚钉固定成功治疗近端腘绳肌断裂，当骨块过小无法进行骨固定时，对于小儿和青少年移位性撕脱骨折可考虑采用这种方法。
