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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Transphyseal ACL Reconstruction in Skeletally Immature Patients
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Transphyseal ACL Reconstruction in Skeletally Immature Patients

机译：胸骨未成熟患者的转椎间痘重建

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Background: Most studies examining the safety and efficacy of transphyseal anterior cruciate ligament (ACL) reconstruction for skeletally immature patients utilize transtibial drilling. Independent femoral tunnel drilling may impart a different pattern of distal femoral physeal involvement. Purpose: To radiographically assess differences in distal femoral physeal disruption between transtibial and independent femoral tunnel drilling. We hypothesized that more oblique tunnels associated with independent drilling involve a significantly larger area of physeal disruption compared with vertically oriented tunnels. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We analyzed skeletally immature patients aged between 10 and 15 years who underwent transphyseal ACL reconstruction utilizing an independent femoral tunnel drilling technique between January 1, 2008, and March 31, 2011. These patients were matched with a transtibial technique cohort based on age and sex. Radiographic measurements were recorded from preoperative magnetic resonance imaging and postoperative radiographs. Results: Ten patients in each group were analyzed. There were significant differences between independent drilling and transtibial drilling cohorts in the estimated area of physeal disruption (1.64 vs 0.74 cm~(2); P < .001), femoral tunnel angles (32.1° vs 72.8°; P < .001), and medial/lateral location of the femoral tunnel (24.2 vs 36.1 mm from lateral cortex; P = .001), respectively. There was a significant inverse correlation between femoral tunnel angle and estimated area of distal femoral physeal disruption ( r = –0.8255, P = .003). Conclusion: Femoral tunnels created with an independent tunnel drilling technique disrupt a larger area of the distal femoral physis and create more eccentric tunnels compared with a transtibial technique. Clinical Relevance: As most studies noting the safety of transphyseal ACL reconstruction have utilized a central, vertical femoral tunnel, surgeons should be aware that if an independent femoral tunnel technique is utilized during transphyseal ACL reconstruction, more physeal tissue is at risk and tunnels are more eccentrically placed across the physis when drilling at more horizontal angles. Prior studies have shown that greater physeal involvement and eccentric tunnels may increase the risk of growth disturbance.
机译：背景：大多数研究检测骨折前十字架韧带（ACL）重建对骨骼未成熟患者的安全性和疗效利用进行打开钻探。独立的股骨隧道钻孔可以赋予不同的远端股质受累模式。目的：放射线地评估雄性和独立股洞隧道钻孔间远端股骨状物理中断的差异。我们假设与独立钻井相关的更多斜隧道涉及与垂直定向的隧道相比具有显着更大的物理性破坏区域。研究设计：横截面研究;证据水平，3.方法：我们分析了在2008年1月1日至2011年1月1日期间的独立股隧道钻探技术接受了10至15岁之间的骨骼未成熟患者，他们在2008年1月1日至3月31日之间进行了独立的股骨隧道钻探技术。这些患者与宁静相匹配技术队列基于年龄和性别。从术前磁共振成像和术后射线照片记录射线照相测量。结果：分析了每组10例患者。在物理性破坏的估计区域（1.64 Vs 0.74cm〜（2）; p <.001），股骨隧道角度（32.1°Vs 72.8°; P <.001）之间存在显着差异股骨隧道的内侧/侧向位置（距离侧面皮质的24.2与36.1mm; p = .001）。股骨隧道角度和远端股骨状虫的估计区域之间存在显着的反比相关性（R = -0.8255，P = .003）。结论：采用独立隧道钻井技术创建的股隧道破坏了远端股骨生理的较大面积，并与串易技术相比产生更多偏心隧道。临床相关性：由于大多数研究记录了失检ACL重建的安全性已经利用了一个中央，垂直的股隧道，外科医生应该知道，如果在转椎间痘重建期间使用独立的股骨隧道技术，则面临风险和隧道更具性能组织在钻入更水平的角度时偏心地放置在液体上。事先研究表明，更大的性能受累和偏心隧道可能会增加生长障碍的风险。

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