Eberl R
Privatklinikum Graz Ragnitz, Berthold-Linder-Weg 15, 8047, Graz, Österreich.
Unfallchirurg. 2019 Jan;122(1):17-21. doi: 10.1007/s00113-018-0589-1.
Anterior cruciate ligament (ACL) ruptures in pediatric patients with open growth plate are of concern and the number of injuries is increasing. The possibilities for diagnostics using magnetic resonance imaging (MRI) have improved and are without radiation exposure to the growing skeleton. The MRI should be performed routinely in every case of adequate trauma also to recognize additional injuries to the knee joint. Joint effusion represents an urgent indication for further clarification. Real ACL ruptures have to be distinguished from bony avulsion injuries. Although there are different forms of treatment, biomechanically an ACL insufficiency is present. A permanent instability leads to degenerative changes of the cartilage and meniscus. Despite the different surgical techniques, the general recommendation is for replacement of the ACL. Extensive procedures with an increased risk of epiphyseal injury should be avoided and anatomical techniques should be preferred. The results are good to very good and with adequate knowledge of the special features of children, complications are rare.
生长板开放的小儿患者前交叉韧带(ACL)断裂令人担忧,且损伤数量不断增加。利用磁共振成像(MRI)进行诊断的可能性有所提高,并且不会对生长中的骨骼造成辐射暴露。对于每一例有足够创伤的病例,都应常规进行MRI检查,以识别膝关节的其他损伤。关节积液是进一步明确诊断的紧急指征。真正的ACL断裂必须与骨撕脱伤相区分。尽管有不同的治疗方式,但从生物力学角度来看存在ACL功能不全。永久性不稳定会导致软骨和半月板的退行性改变。尽管有不同的手术技术,但一般建议进行ACL置换。应避免采用骨骺损伤风险增加的广泛手术方法,而应优先选择解剖学技术。结果良好至非常好,并且充分了解儿童的特殊情况后,并发症很少见。