1、儿童前交叉韧带损伤重建,广西中医药大学第一附属医院骨关节创伤手外科国家卫生部骨科内镜与微创医学广西培训基地席智杰,Caine D, Maffulli N, Caine C. Epidemiology of injury in child and adolescent sports: injury rates, risk factors, and prevention. Clin Sports Med. 2008;27:19-50.,流行病学,ACL损伤是活跃儿童最严重、发病率最高的运动相关性损伤之一，发病率在上升,5-18岁高发，占膝关节损伤的31%女:男=2.8青春期前部分撕裂、止点撕脱青春
2、期后完全撕裂,1 K. G. Shea, R. Pfeiffer, H. W. Jo, M. Curtin, and P. J. Apel, “Anterior cruciate ligament injury in pediatric and adolescent soccer players: an analysis of insurance data,” Journal of Pediatric Orthopaedics, vol. 24, no. 6, pp. 623628, 2004.2 J. S. Prince, T. Laor, and J. A. Bean, “MRI of a
3、nterior cruciate ligament injuries and associated findings in the pediatric knee: changes with skeletal maturation,” American Journal of Roentgenology, vol. 185, no. 3, pp. 756762, 2005.,儿童的ACL损伤的特殊性,骨骺给治疗带来很多障碍,膝关节骨骺:下肢2/3长度骨骺闭合时间:男: 6-18 ，女: 14-16,合并伤较少,10岁以下很少有半月板和关节软骨的损伤早期OA的可能性小,HAVARD MOKSNES,
4、 LARS ENGEBRETSEN,MAY ARNA RISBERG. Management of Anterior Cruciate Ligament Injuries in Skeletally Immature Individuals. journal of orthopaedic & sports physical therapy.2012 ,42 (3): 172-183.,诊断困难,儿童的ACL较成人松弛儿童的MRI检查特异性和敏感性下降,自愈能力强治疗方案的特殊性,Joshua L. Hudgens and Diane L. Dahm. Treatment of Anterior
5、 Cruciate Ligament Injury in Skeletally Immature PatientJ.sHindawi Publishing Corporation International Journal of Pediatrics Volume 2012, Article ID 932702, 6 pages doi:10.1155/2012/932702,VS,P. Vavken and M. M. Murray, “Treating anterior cruciate ligament tears in skeletally immature patients,” Ar
6、throscopy, vol. 27, no. 5, pp. 704716, 2011.,VS,手术方法,HAVARD MOKSNES, LARS ENGEBRETSEN,MAY ARNA RISBERG. Management of Anterior Cruciate Ligament Injuries in Skeletally Immature Individuals. journal of orthopaedic & sports physical therapy.2012 ,42 (3): 172-183.,非解剖重建：骨-髌腱-骨重建,非解剖重建：髂胫束重建,非解剖重建：髂胫束重建
7、,非解剖重建：髂胫束重建,如何进行儿童的解剖重建？,解剖重建 内口解剖,MRI-,关节镜下所见，ACL实质部偏下方断裂。,如此严重的损伤必定有合并伤！,外侧半月板后角瓣状裂,利用ACL瞄准器定位股骨隧道内口及外口,通过瞄准器钻入导针,利用ACL瞄准器定位胫骨隧道内口及外口。,ACL内口比较重要。,残根用缝合钩缝合，用PDS-保残,电视透视避开骨骺线,电视透视避开骨骺线,透视证实后钻空心钻头。,穿入钢丝准备引线,将半腱肌及股薄肌编织。,将半腱肌及股薄肌引入。,将半腱肌及股薄肌引入。,将半腱肌及股薄肌引入。,韧带重建后，检查张力好。,PDS-在胫骨外口缝合固定。,可以用钮扣钢板固定,儿童ACL重建不是简单的手术，必须高度重视。,谢谢！,
