Fujita Kentaro, Nakase Junsuke, Yoshimizu Rikuto, Kimura Mitsuhiro, Kanayama Tomoyuki, Tsuchiya Hiroyuki
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Japan.
Arthrosc Tech. 2022 Apr 22;11(5):e841-e846. doi: 10.1016/j.eats.2021.12.043. eCollection 2022 May.
Osgood-Schlatter disease commonly affects physically active adolescents. It is a common cause of anterior knee pain and inflammation in this population. Its symptoms typically subside with conservative therapy. Surgery, including resection of mobile ossicles, is considered when the pain persists on kneeling or during sports after the skeletal maturity. In this procedure, we use a direct bursoscopic approach with ultrasound-guided ossicle resection. In comparison with the classical arthroscopic approach, the bursoscopic approach uses more distally placed portals. These reduce the risk of damage to the fat pad, meniscus, and ligament. Endoscopic surgeries, including arthroscopic and bursoscopic surgeries, use intraoperative fluoroscopy to resect ossicles because the ossicle cannot be clearly identified by endoscopic imaging alone. Fluoroscopy exposes patients and surgeons to radiation. Ultrasound-guided surgery identifies the exact positional relationship between the ossicle and grasping forceps without radiation exposure since fluoroscopy is unnecessary. Moreover, the risk of residual ossicles is reduced because tiny ossicles, which are difficult to detect under fluoroscopy, are visible on ultrasound. Ultrasound-guided ossicle resection was a viable treatment option for Osgood-Schlatter disease because it eliminated radiation exposure and reduced the risk of missed ossicles.
奥斯古德-施拉特病通常影响身体活跃的青少年。它是该人群膝前疼痛和炎症的常见原因。其症状通常通过保守治疗而缓解。当骨骼成熟后，在跪姿或运动时疼痛持续存在时，考虑进行手术，包括切除活动小骨。在本手术中，我们采用直接关节镜下超声引导小骨切除术。与传统关节镜手术相比，关节镜下手术使用的切口位置更靠下。这些切口降低了损伤脂肪垫、半月板和韧带的风险。包括关节镜手术和关节镜下手术在内的内镜手术，术中使用荧光透视来切除小骨，因为仅通过内镜成像无法清晰识别小骨。荧光透视会使患者和外科医生暴露于辐射。超声引导手术无需荧光透视即可确定小骨与抓钳之间的确切位置关系，从而避免辐射暴露。此外，由于在荧光透视下难以检测到的微小残留小骨在超声下可见，残留小骨的风险降低。超声引导小骨切除术是治疗奥斯古德-施拉特病的一种可行选择，因为它消除了辐射暴露并降低了遗漏小骨的风险。
