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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Factors Affecting the Preferred Surgical Technique in Pediatric Anterior Cruciate Ligament Reconstruction
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Factors Affecting the Preferred Surgical Technique in Pediatric Anterior Cruciate Ligament Reconstruction

机译：影响小儿前十字韧带重建术中首选手术技术的因素

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Background: Despite several well-described operative techniques, the optimal management of anterior cruciate ligament (ACL) injuries in pediatric patients remains unclear. Purpose: To identify surgeons’ preferred ACL reconstruction techniques and postoperative protocols for pediatric patients of various ages. Study Design: Cross-sectional study. Methods: An electronic survey was administered to surgeons in the Pediatric Research in Sports Medicine (PRiSM) society, resulting in a cohort of experienced respondents who performed a relatively high volume of ACL reconstructions in skeletally immature patients. Surgeon and practice demographic information was recorded. The survey presented the scenario of a patient who had a physical examination and imaging consistent with an acute, isolated ACL tear. The respondents were asked to select their preferred reconstruction technique for female and male patients at consecutive skeletal ages from 8 to 15 years. Surgeons were also asked about postoperative protocol. Results: Of 103 surgeons, 88 (85%) responded to the survey, the majority of whom (68%) performed more than 25 pediatric ACL reconstructions annually. The greatest variation in technique was from ages 11 to 13 years in female patients and from 11 to 14 years in male patients. The modified MacIntosh was the most frequently used technique for patients aged 8 to 10 years. An all-epiphyseal technique was preferred over a broader age range in male patients than female patients, with peak use at age 11 in both. A partial transphyseal (hybrid) technique was preferred in slightly older patients, with peak use at age 12 in female patients and 13 in male patients. The transphyseal technique was most widely used at age 13 and older in female patients and 14 and older in male patients. The impact of fellowship training (pediatrics, sports, or both) on technique preference was statistically significant for male patients aged 11 to 13 and female patients 11 and 12 (all P & .05). Surgeons with pediatric orthopaedic training tended to prefer an all-epiphyseal reconstruction, while those with both pediatric and sports medicine training preferred the modified MacIntosh. Conclusion: The preferred ACL reconstruction technique varied considerably, especially for patients aged 11 to 13 years. The modified MacIntosh reconstruction was favored in patients aged 10 years or younger, while the transphyseal technique was preferred in female patients aged 13 years and older and in male patients 14 years and older. The surgeon’s fellowship training was significantly associated with his or her preferred surgical technique.
机译：背景：尽管有几种众所周知的手术技术，但小儿患者前十字韧带（ACL）损伤的最佳治疗仍不清楚。目的：为不同年龄的儿科患者确定外科医生首选的ACL重建技术和术后方案。研究设计：横断面研究。方法：对运动医学儿科研究（PRiSM）学会的外科医生进行了电子调查，结果产生了一批经验丰富的受访者，他们在骨骼未成熟的患者中进行了相对大量的ACL重建。记录了外科医生和诊所的人口统计信息。这项调查显示了接受物理检查和影像学检查并符合急性，孤立的ACL撕裂的患者的情况。要求受访者为连续骨骼年龄为8至15岁的女性和男性患者选择首选的重建技术。还询问了外科医生有关术后方案的信息。结果：在103位外科医生中，有88位（85％）回答了该调查，其中大多数（68％）每年进行了25次以上的儿科ACL重建。技术上最大的变化是女性患者从11岁到13岁，男性患者从11岁到14岁。改良的MacIntosh是8至10岁患者最常用的技术。与女性患者相比，男性患者在更广泛的年龄范围内首选全-骨技术，两者均在11岁时达到峰值。对于年龄稍大的患者，最好采用部分透支（混合）技术，女性患者在12岁时使用高峰，男性患者则在13岁时使用高峰。透骨移植技术在13岁及以上的女性患者和14岁及以上的男性患者中使用最广泛。对于11至13岁的男性患者和11至12岁的女性患者，研究金培训（儿科，运动或两者兼而有之）对技术偏爱的影响在统计学上具有显着意义（所有P <.05）。接受小儿整形外科培训的外科医生倾向于全脊椎重建术，而接受儿科和运动医学培训的外科医生则首选改良型MacIntosh。结论：首选的ACL重建技术差异很大，尤其是对于11至13岁的患者。改良的MacIntosh重建术适合10岁或更年轻的患者，而透骨移植技术更适合13岁以上的女性患者和14岁以上的男性患者。外科医生的进修培训与他或她偏爱的手术技术有很大关系。

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