未成年人交叉韌帶重建CruciateLigamentReconstructioninSkeletallyImmaturePatients廣東省中醫院二沙島分院骨科許樹柴黃澤鑫未成年人交叉韌帶重建1為什么要重建未成年人完全斷裂的前交叉?循證醫學證據·1.半月板損傷meniscusinJury·2軟骨損傷cartilagedamage3.保守治療是無賴之舉4.兒童/少年制動是一件難事為什么要重建未成年人完全斷裂的2All-EpiphysealAnteriorCruciateLigamentReconstructioninSkeletallyImmaturePatients:ASurgicalTechniqueUsingaSplitTibialTunnelMariosG.Lykissas,MD,Ph.D.ChildersshospitalMedictce.333BPneavemoczttpcinci.edH4SZ2UlsaManytechniqueshavebeendescribedforanteriorcruciateligament(ACL)reconstructioninskeletallyimmaturepatientsncludingphyseal-sparingtechniques(骨骺保護技術),Andextra-articular(關節外技術)completeorpartialtransphysea(通過骨骺技術),All-EpiphysealAnteriorCrucia3Anall-epiphysealquadruple-hamstringACLreconstructionusingasplittibialtunnel全骨骺內,股薄肌/半腱肌分開通過脛骨隧道Thesplittibialtunnelsdropthetunnelsizedownto4.5to5.5mmbecauseonlyhalfthetotalgraftdiameterpassesthrougheachofthesplittunnels.ThisincreasesthesafetymarginforkeepingthetunnelwithinthetibialepiphysisinadditiontoavoidingdamageintothegrowthplateAnall-epiphysealquadruple-ha4Modifiedall-epiphysealACLreconstruction.(A)Afemoraltunnelandasplittibialtunnelareplacedentirelywithinthedistalfemoralandproximaltibialepiphysis,respectively.(B)Biocompositeinterferencescrew(Matryx)isusedtofixthegraftintothefemoraltunnel.A1-cmbonebridgebetweenthe2tibialtunnelsismaintained.(C)中間1cM的骨橋保護Lateralillustrationoftheall-epiphysealtechniqueshowingthecorrectpositionofthefemoraltunnelinthelateralplane,aswellastheloopedendofthegraftaroundtheanteromedialtibialepiphysisModifiedall-epiphysealACLre5骨骼未成年人交叉韌帶體部完全斷裂修復方法課件6骨骼未成年人交叉韌帶體部完全斷裂修復方法課件7骨骼未成年人交叉韌帶體部完全斷裂修復方法課件8骨骼未成年人交叉韌帶體部完全斷裂修復方法課件9骨骼未成年人交叉韌帶體部完全斷裂修復方法課件10骨骼未成年人交叉韌帶體部完全斷裂修復方法課件11骨骼未成年人交叉韌帶體部完全斷裂修復方法課件12骨骼未成年人交叉韌帶體部完全斷裂修復方法課件13骨骼未成年人交叉韌帶體部完全斷裂修復方法課件14骨骼未成年人交叉韌帶體部完全斷裂修復方法課件15骨骼未成年人交叉韌帶體部完全斷裂修復方法課件16骨骼未成年人交叉韌帶體部完全斷裂修復方法課件17骨骼未成年人交叉韌帶體部完全斷裂修復方法課件18骨骼未成年人交叉韌帶體部完全斷裂修復方法課件19骨骼未成年人交叉韌帶體部完全斷裂修復方法課件20骨骼未成年人交叉韌帶體部完全斷裂修復方法課件21骨骼未成年人交叉韌帶體部完全斷裂修復方法課件22骨骼未成年人交叉韌帶體部完全斷裂修復方法課件23骨骼未成年人交叉韌帶體部完全斷裂修復方法課件24骨骼未成年人交叉韌帶體部完全斷裂修復方法課件25骨骼未成年人交叉韌帶體部完全斷裂修復方法課件26骨骼未成年人交叉韌帶體部完全斷裂修復方法課件27骨骼未成年人交叉韌帶體部完全斷裂修復方法課件28骨骼未成年人交叉韌帶體部完全斷裂修復方法課件29骨骼未成年人交叉韌帶體部完全斷裂修復方法課件30骨骼未成年人交叉韌帶體部完全斷裂修復方法課件31骨骼未成年人交叉韌帶體部完全斷裂修復方法課件32骨骼未成年人交叉韌帶體部完全斷裂修復方法課件33骨骼未成年人交叉韌帶體部完全斷裂修復方法課件34骨骼未成年人交叉韌帶體部完全斷裂修復方法課件35骨骼未成年人交叉韌帶體部完全斷裂修復方法課件36骨骼未成年人交叉韌帶體部完全斷裂修復方法課件37骨骼未成年人交叉韌帶體部完全斷裂修復方法課件38骨骼未成年人交叉韌帶體部完全斷裂修復方法課件39骨骼未成年人交叉韌帶體部完全斷裂修復方法課件40骨骼未成年人交叉韌帶體部完全斷裂修復方法課件41骨骼未成年人交叉韌帶體部完全斷裂修復方法課件42骨骼未成年人交叉韌帶體部完全斷裂修復方法課件43骨骼未成年人交叉韌帶體部完全斷裂修復方法課件44骨骼未成年人交叉韌帶體部完全斷裂修復方法課件45骨骼未成年人交叉韌帶體部完全斷裂修復方法課件46骨骼未成年人交叉韌帶體部完全斷裂修復方法課件47骨骼未成年人交叉韌帶體部完全斷裂修復方法課件48骨骼未成年人交叉韌帶體部完全斷裂修復方法課件49骨骼未成年人交叉韌帶體部完全斷裂修復方法課件50骨骼未成年人交叉韌帶體部完全斷裂修復方法課件51骨骼未成年人交叉韌帶體部完全斷裂修復方法課件52骨骼未成年人交叉韌帶體部完全斷裂修復方法課件53骨骼未成年人交叉韌帶體部完全斷裂修復方法課件54骨骼未成年人交叉韌帶體部完全斷裂修復方法課件55骨骼未成年人交叉韌帶體部完全斷裂修復方法課件56骨骼未成年人交叉韌帶體部完全斷裂修復方法課件57未成年人交叉韌帶重建CruciateLigamentReconstructioninSkeletallyImmaturePatients廣東省中醫院二沙島分院骨科許樹柴黃澤鑫未成年人交叉韌帶重建58為什么要重建未成年人完全斷裂的前交叉?循證醫學證據·1.半月板損傷meniscusinJury·2軟骨損傷cartilagedamage3.保守治療是無賴之舉4.兒童/少年制動是一件難事為什么要重建未成年人完全斷裂的59All-EpiphysealAnteriorCruciateLigamentReconstructioninSkeletallyImmaturePatients:ASurgicalTechniqueUsingaSplitTibialTunnelMariosG.Lykissas,MD,Ph.D.ChildersshospitalMedictce.333BPneavemoczttpcinci.edH4SZ2UlsaManytechniqueshavebeendescribedforanteriorcruciateligament(ACL)reconstructioninskeletallyimmaturepatientsncludingphyseal-sparingtechniques(骨骺保護技術),Andextra-articular(關節外技術)completeorpartialtransphysea(通過骨骺技術),All-EpiphysealAnteriorCrucia60Anall-epiphysealquadruple-hamstringACLreconstructionusingasplittibialtunnel全骨骺內,股薄肌/半腱肌分開通過脛骨隧道Thesplittibialtunnelsdropthetunnelsizedownto4.5to5.5mmbecauseonlyhalfthetotalgraftdiameterpassesthrougheachofthesplittunnels.ThisincreasesthesafetymarginforkeepingthetunnelwithinthetibialepiphysisinadditiontoavoidingdamageintothegrowthplateAnall-epiphysealquadruple-ha61Modifiedall-epiphysealACLreconstruction.(A)Afemoraltunnelandasplittibialtunnelareplacedentirelywithinthedistalfemoralandproximaltibialepiphysis,respectively.(B)Biocompositeinterferencescrew(Matryx)isusedtofixthegraftintothefemoraltunnel.A1-cmbonebridgebetweenthe2tibialtunnelsismaintained.(C)中間1cM的骨橋保護Lateralillustrationoftheall-epiphysealtechniqueshowingthecorrectpositionofthefemoraltunnelinthelateralplane,aswellastheloopedendofthegraftaroundtheanteromedialtibialepiphysisModifiedall-epiphysealACLre62骨骼未成年人交叉韌帶體部完全斷裂修復方法課件63骨骼未成年人交叉韌帶體部完全斷裂修復方法課件64骨骼未成年人交叉韌帶體部完全斷裂修復方法課件65骨骼未成年人交叉韌帶體部完全斷裂修復方法課件66骨骼未成年人交叉韌帶體部完全斷裂修復方法課件67骨骼未成年人交叉韌帶體部完全斷裂修復方法課件68骨骼未成年人交叉韌帶體部完全斷裂修復方法課件69骨骼未成年人交叉韌帶體部完全斷裂修復方法課件70骨骼未成年人交叉韌帶體部完全斷裂修復方法課件71骨骼未成年人交叉韌帶體部完全斷裂修復方法課件72骨骼未成年人交叉韌帶體部完全斷裂修復方法課件73骨骼未成年人交叉韌帶體部完全斷裂修復方法課件74骨骼未成年人交叉韌帶體部完全斷裂修復方法課件75骨骼未成年人交叉韌帶體部完全斷裂修復方法課件76骨骼未成年人交叉韌帶體部完全斷裂修復方法課件77骨骼未成年人交叉韌帶體部完全斷裂修復方法課件78骨骼未成年人交叉韌帶體部完全斷裂修復方法課件79骨骼未成年人交叉韌帶體部完全斷裂修復方法課件80骨骼未成年人交叉韌帶體部完全斷裂修復方法課件81骨骼未成年人交叉韌帶體部完全斷裂修復方法課件82骨骼未成年人交叉韌帶體部完全斷裂修復方法課件83骨骼未成年人交叉韌帶體部完全斷裂修復方法課件84骨骼未成年人交叉韌帶體部完全斷裂修復方法課件85骨骼未成年人交叉韌帶體部完全斷裂修復方法課件86骨骼未成年人交叉韌帶體部完全斷裂修復方法課件87骨骼未成年人交叉韌帶體部完全斷裂修復方法課件88骨骼未成年人交叉韌帶體部完全斷裂修復方法課件89骨骼未成年人交叉韌帶體部完全斷裂修復方法課件90骨骼未成年人交叉韌帶體部完全斷裂修