Würfel A, Hofmann-von Kap-herr S H, Engel V, Linke F
Klinik und Poliklinik für Kinderchirurgie, Johannes-Gutenberg-Universität Mainz.
Unfallchirurgie. 1995 Jun;21(3):124-9. doi: 10.1007/BF02589949.
Between 1970 and 1993 29 fractures of the intercondylar eminence were seen in children with almost the same number of cases showing no or minor displacement as those requiring open reduction for major dislocation. Combined knee injury must be suspected the higher the patient's age and the more pronounced the displacement of the fragment. Magnetic resonance imaging (MRI) has gained diagnostic predominance. Arthroscopy remains important for surgical management, especially of associated meniscus and cartilage damage. Early puncture of hemarthrosis is essential. Closed management is the therapy for nondisplaced fragments or those with bone contact or only tuberculum fractures--while displaced fragments require operative reduction. Arthroscopy-aided wire fixation is the preferred technique, followed by open reduction using absorbable suture material (wire in special cases). Traction screws should be used only in older children with large fragments. Our series show good late results because occasional function impairment with knee instability tends to normalize with growth. Corrective orthopedic procedures--if at all--are required only for juveniles or adults.
1970年至1993年间,共发现29例儿童髁间隆起骨折,未移位或轻度移位的病例数与因严重脱位而需要切开复位的病例数几乎相同。患者年龄越大,骨折块移位越明显,就越应怀疑合并有膝关节损伤。磁共振成像(MRI)已在诊断中占据主导地位。关节镜检查对于手术治疗,尤其是对于合并的半月板和软骨损伤的治疗,仍然很重要。早期穿刺关节积血至关重要。对于无移位的骨折块或有骨接触的骨折块或仅为结节骨折,采用闭合治疗;而移位的骨折块则需要手术复位。关节镜辅助钢丝固定是首选技术,其次是使用可吸收缝合材料进行切开复位(特殊情况下使用钢丝)。牵引螺钉仅适用于骨折块较大的大龄儿童。我们的系列病例显示出良好的后期效果,因为偶尔出现的膝关节不稳定功能障碍往往会随着生长而恢复正常。仅在青少年或成年人中才需要进行矫正骨科手术(如果确实需要的话)。