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引用次数: 0
摘要
青少年参与体育运动的人数不断增加,导致越来越多的膝关节损伤需要手术治疗。在最年轻的运动员中,此类手术通常涉及尊重骨骺的前交叉韧带重建技术、治疗髌骨不稳的髌股内侧韧带重建技术、骨软骨炎固定术以及植入物引导生长术。在每种情况下,选择适当的干预措施都与患者的骨骼成熟度密切相关。与生理年龄相比,骨骼年龄反映了个体的成熟度,是确定骨科发育的基准。历史上使用 Greulich 和 Pyle 方法对骨骼年龄进行评估,该方法通过将患者的手部 X 光片与 20 世纪初美国儿童图册中最接近的标准 X 光片进行比较来确定骨龄。在膝关节病变的情况下,获得额外的成像需要更多的辐射和时间。有几种骨龄测定方法结合了股骨远端、胫骨近端和/或腓骨近端的放射学特征。因此,本研究试图回顾现有的骨骼年龄测定方法,以便在规划膝关节手术时使用现成的常规膝关节成像。综述重点关注外科医生可用于指导适当治疗的基于X光片和核磁共振成像的骨骼成熟度分期系统,同时介绍了每种方法的优缺点。
Methods of Assessing Skeletal Maturity When Planning Surgeries About the Knee.
Increased participation in youth sports has led to more knee injuries necessitating surgical intervention. Among the youngest athletes, such procedures typically involve physeal-respecting techniques for anterior cruciate ligament reconstruction, medial patellofemoral ligament reconstruction for patellar instability, osteochondritis dissecans fixation, and implant-mediated guided growth procedures. In each case, the choice of appropriate intervention is critically dependent on a patient's skeletal maturity. Compared with chronologic age, skeletal age accounts for individual maturation and is the benchmark for determination of development in orthopaedics. This is historically assessed using the Greulich and Pyle method, in which bone age is determined through comparison of a patient's hand radiograph with the closest standard radiograph from an atlas of American children from the early 1900s. In the setting of knee pathology, obtaining additional imaging requires further radiation and time. Several bone age determination methods exist incorporating radiographic characteristics of the distal femur, proximal tibia, and/or proximal fibula. This study therefore sought to review available methods for determination of skeletal age when planning surgeries about the knee using readily available, routine knee imaging. The review focuses on both radiograph and MRI-based skeletal maturity staging systems that surgeons may use to guide appropriate treatment while describing the strengths and weaknesses of each method.
期刊介绍:
The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues.
Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.