Rách dây chằng chéo trước ở trẻ em: tái tạo sớm với physis hở hay tái tạo muộn đến độ trưởng thành của xương?

Wiley - Tập 17 - Trang 748-755 - 2009
Julien Henry1, Franck Chotel2, Julien Chouteau1, Michel Henri Fessy1, Jérôme Bérard2, Bernard Moyen1
1Service de chirurgie orthopédique, de traumatologie et de médecine du sport, Centre Hospitalier Lyon-Sud, Pierre Bénite, Cedex, France
2Service de Chirurgie Orthopédique Pédiatrique, Hôpital Universitaire Mère Enfant de Lyon, Bron, France

Tóm tắt

Mục đích của nghiên cứu này là so sánh hai chiến lược quản lý khác nhau đối với rách dây chằng chéo trước (ACL) ở bệnh nhân đang trong giai đoạn phát triển xương. Nhóm 1, các bệnh nhân được điều trị tại bệnh viện nhi với phẫu thuật tái tạo ACL có physis hở. Nhóm 2, các bệnh nhân được điều trị tại bệnh viện người lớn với phẫu thuật tái tạo muộn khi đã đánh giá sự trưởng thành của xương qua hình ảnh học. Nghiên cứu hồi cứu này bao gồm 56 bệnh nhân liên tiếp. Thời gian trung bình từ chấn thương đến phẫu thuật ở nhóm 1 và nhóm 2 lần lượt là 13.5 và 30 tháng. Bệnh nhân ở nhóm 2 có tỷ lệ rách sụn chêm trong cao hơn (41%) so với nhóm 1 (16%) và tỷ lệ cắt sụn chêm cao hơn. Cả hai nhóm có tỷ lệ rách sụn chêm bên ngoài tương đương nhau. Một biến dạng khớp gối tạm thời do valgus được báo cáo nhưng sau đó tự biến mất. Không có rối loạn phát triển xương nào được nhận thấy. Sau thời gian theo dõi trung bình 27 tháng, điểm IKDC chủ quan tốt nhất được ghi nhận ở nhóm 1. Kết quả IKDC khách quan và kết quả hình ảnh học cũng tương tự ở cả hai nhóm. Do đó, tái tạo ACL sớm là một lựa chọn được khuyến nghị.

Từ khóa

#rách dây chằng chéo trước #trẻ em #phẫu thuật tái tạo #biến dạng khớp gối #sụn chêm

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