Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients - A preliminary report
Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients - A preliminary report
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DOI：
10.2106/00004623-200307000-00011
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发表时间：
2003-07-01
影响因子：
5.3
通讯作者：
Anderson, AF
中科院分区：
文献类型：
--
作者：
Anderson, AF
背景资料：对医源性生长障碍的恐惧阻止了在儿童中常规使用在成人中已被证明成功的前交叉韧带置换的解剖方法。为了最大限度地减少生长障碍的风险，已进行关节外或改良的骨骺保留手术来稳定膝关节，但这些手术不能提供等距。本研究旨在评估经骺板置换前交叉韧带治疗未成年运动员的结果。方法：从1993年到1999年，12名患者，平均年龄（和标准差）13.3 +/-1.4年，采用关节镜技术和术中荧光镜检查，用四股腘绳肌腱移植物置换前交叉韧带成像以实现精确的隧道放置。股骨和胫骨隧道穿过骺，但避开骺。12名患者中有8名还接受了尿道修复术。所有患者返回随访，在平均4.1 +/- 1.9年（范围，2至8.2年）surgery.Results：从手术时间到随访时间的平均增长量为16.5 +/- 10.0 cm（范围，8至38 cm）。在正射X线片上测量的下肢长度之间的差异不具有临床意义。国际膝关节文献委员会（IKDC）膝关节主观量表的平均评分为96.5 +/- 4.4分（范围：86 - 100分）。使用KT-1000关节测量仪进行的韧带松弛测试显示，平均侧-侧差异为1.5 +/- 1.1 mm。根据2001年IKDC膝关节形态客观标准，7名患者的评分正常，5名患者接近正常。结论：前交叉韧带的经骺置换术是一项技术要求很高的手术，误差范围很小，只有经验丰富的膝关节外科医生才能尝试。在这个小系列的初步结果，然而，证明这种手术技术可以在青春期前的患者进行的有效性和相对safety.Level证据：治疗性研究，I级（病例系列[无，或历史，对照组]）。证据等级的完整描述见作者说明。
Background: Fear of iatrogenic growth disturbance has prevented the routine use, in children, of anatomic methods of anterior cruciate ligament replacement that have proven successful in adults. To minimize the risk of growth disturbance, extra-articular or modified physeal sparing procedures have been performed to stabilize the knee, but these procedures do not provide isometry. This study was performed to evaluate the results of a transepiphyseal replacement of the anterior cruciate ligament in skeletally immature athletes.Methods: From 1993 to 1999, twelve patients with a mean age (and standard deviation) of 13.3 +/- 1.4 years underwent replacement of the anterior cruciate ligament with a quadruple hamstring tendon graft performed with an arthroscopic technique and intraoperative fluoroscopic imaging for precise tunnel placement. The femoral and tibial tunnels went through the epiphyses but avoided the physes. Eight of the twelve patients also had a meniscal repair. All patients returned for follow-up, at a mean of 4.1 +/- 1.9 years (range, two to 8.2 years) after surgery.Results: The mean amount of growth from the time of surgery to the time of follow-up was 16.5 +/- 10.0 cm (range, 8 to 38 cm). The difference between the lengths of the lower limbs, as measured on orthoradiographs, was not clinically relevant. The mean score on the International Knee Documentation Committee (IKDC) subjective knee form was 96.5 +/- 4.4 points (range, 86 to 100 points). Ligament laxity testing with a KT-1000 arthrometer revealed a mean side-to-side difference of 1.5 +/- 1.1 mm. The rating according to the criteria of the objective 2001 IKDC knee form was normal for seven patients and nearly normal for five.Conclusions: Transepiphyseal replacement of the anterior cruciate ligament, a technically demanding procedure with a small margin of error, should be attempted only by accomplished knee surgeons. The preliminary results in this small series, however, demonstrate that this surgical technique can be performed in prepubescent patients with efficacy and relative safety.Level of Evidence: Therapeutic study, Level I (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.