Bauer J, Orendi I, Ladenhauf H N, Neubauer T
Universitätsklinik für Kinder und Jugendchirurgie, Paracelsus Medizinische Privatuniversität Salzburg, Müllner Hauptstr. 48, Salzburg, Österreich.
Unfallchirurgische Abteilung, Landeskrankenhaus Horn, Spitalgasse 10, 3580, Horn, Österreich.
Unfallchirurg. 2019 Jan;122(1):6-16. doi: 10.1007/s00113-018-0590-8.
While fractures around the knee are known to be rare, physicians have encountered a rise in the frequency due to the increased participation of children and adolescents in high-impact sports at a younger age. Even if the treatment of fractures in some cases resembles that in adults, the diagnostics and treatment in childhood and adolescence require a hígh level of experience in order avoid possible sequelae and to enable early recognition. Thorough diagnostics using clinical and imaging investigations as well as a precise weighing up of the treatment are essential to minimize differences in leg length and axial malpositioning of the leg. A decision between conservative and operative treatment is made for both the femur and tibia depending on the type of fracture. Decisive is the degree of dislocation of the fracture. In operative treatment, the axis conform reduction and subsequent stress stable treatment are particularly decisive. Avulsion trauma, bony avulsions of the intercondylar eminence and patellar injuries are also treated conservatively with immobilization or surgically with the aid of various fixation techniques, depending on the degree of dislocation.
虽然已知膝关节周围骨折很少见,但由于儿童和青少年在更小的年龄就更多地参与高冲击力运动,医生们遇到此类骨折的频率有所上升。即使某些情况下骨折的治疗与成人相似,但儿童和青少年时期的诊断和治疗仍需要高水平的经验,以避免可能的后遗症并实现早期识别。使用临床和影像学检查进行全面诊断以及对治疗进行精确权衡,对于尽量减少腿长差异和腿部轴向错位至关重要。根据骨折类型,对股骨和胫骨都要做出保守治疗还是手术治疗的决定。关键在于骨折的脱位程度。在手术治疗中,轴向复位和随后的应力稳定治疗尤为关键。对于撕脱伤、髁间隆起的骨撕脱以及髌骨损伤,也根据脱位程度采用固定保守治疗或借助各种固定技术进行手术治疗。