儿童单纯性膝关节骨软骨骨折的关节镜治疗

Arthroscopic therapy of osteochondral fractures of the Knee in children

目的 探讨小儿单纯性膝关节髌骨、股骨髁骨软骨骨折的关节镜诊断与处理方法.方法 2008～2010年四川大学华西医院经关节镜诊治小儿单纯性膝关节髌骨、股骨髁骨软骨骨折患儿9例,其中男3例,女6例,年龄7～15岁（平均11.3岁）,病程3 d至4周（平均1周）,左膝4例,右膝5例.其中髌骨4例,股骨内髁3例,外髁2例.3例为单纯性软骨骨折,改良Outerbridge分级为Ⅲ级,6例骨折累及软骨下骨,改良Outerbridge分级为Ⅳ级.1例采用可吸收螺钉内固定,2例行微骨折术钻孔处理以刺激软骨生长,6例行单纯关节清理术.结果 伤口均I期愈合,无相关并发症发生.术后5～7 d膝关节肿胀、疼痛基本消失,2周左右重返学校,6周左右拆除膝关节保护支具开始膝关节正常负重工作.随访3～9个月,平均6个月,膝关节lysholms评分均为优,Tegner运动评级4级以上,患儿原有症状消失,膝关节功能恢复正常.结论 对于小儿单纯性膝关节骨软骨骨折,关节镜下早期诊断和治疗是一种有效的治疗方法.

Objective To investigate the arthroscopic operative procedure and the therapeutic effects of patella and femur condyle osteochondral fracture of knee joint in children. Methods From 2008 to 2010, 9 patients with patella and femur condyle osteochondral fracture of knee joint were treated with arthroscopic diagnosis and therapy. There were 3 males and 6 females, aged from 7 to 15 years （ 11.3 years on average） , course of disease from 3 days to 4 weeks （ 1 week on average）. There were 4 left and 5 right, including 4 cases of patella, 3 cases of femoral condyle, 2 cases of lateral condyle. 3 cases of simple fracture of the cartilage, as modified Outerbridge grade Ⅲ level, 6 cases of fractures involving the subchondral bone, as modified Outerbridge grade Ⅳ level. 1 case was treated with absorbable screw fixation, 2 cases were dealed by microfracture surgery to stimulate cartilage growth drilling, joint debridement alone in 6 eases. Results All incisions healed by first intention, no related complications occurred. 5 to 7 days after knee swelling and pain disappeared, back to school about 2 weeks, 6 weeks of knee protection removal of the normal weight-bearing knee brace started work. A total of 9 patients were followed up 3 months to 9 months （6 months on average）. All cases were excellent knee Lyshohns score and more than 4 mean Tegner activity level scale improved. The original symptoms in children were disappeared, restore normal knee function. Conclusion For children with simple knee osteochondral fracture, early diagnosis and treatment by arthroscope is an effective treatment.