在幼年性剥离性骨软骨炎损伤修复过程中，14mm的螺钉长度足以避免物理损伤，但这可能因年龄和股骨远端区域而异

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-02-01 DOI:10.1016/j.asmr.2024.101011

Patrick A. Massey M.D., M.B.A. , Gabriel Sampognaro M.D. , Lincoln Andre M.D. , Bradley Nelson M.D. , Robert Rutz M.D. , Henry Craighead B.S. , Alberto Simoncini M.D.

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From these points, we measured the shortest distance from the articular surface to the physis, noting the shortest distances. These measurements simulated screw lengths in the anterior, posterior, and central regions on both the medial and lateral condyle. Statistical analysis was performed to determine the 95% confidence interval for all measurements. Analysis of variance was performed to compare different regions.</div></div><div><h3>Results</h3><div>A total of 97 knee magnetic resonance images from patients aged 6 to 17 years were reviewed. The safe screw lengths among all samples were 14.1 mm, 20.9 mm, 18.2 mm, 14.4 mm, 17.5 mm, and 14.1 mm for the anteromedial, central medial, posteromedial, anterolateral, central lateral, and posterolateral regions, respectively. There was a difference in simulated screw lengths among all 6 groups (<em>P</em> < .001). 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引用次数: 0

摘要

目的探讨避免刺穿股骨骨性软骨炎病变手术固定的安全螺钉长度，并比较不同髁段的安全螺钉长度。方法经机构审查委员会批准，我们回顾性分析了儿童患者的t1加权磁共振图像。在股骨上做纵轴基准线。然后将线放置在该轴前后45°处，以模拟螺钉起点。从这些点，我们测量了从关节面到身体的最短距离，注意到最短距离。这些测量模拟了内外侧髁的前、后、中心区域的螺钉长度。进行统计分析以确定所有测量值的95%置信区间。对不同地区进行方差分析比较。结果回顾性分析6 ~ 17岁患者共97张膝关节磁共振图像。对于前内侧、中央内侧、后内侧、前外侧、中央外侧和后外侧区域，所有样本的安全螺钉长度分别为14.1 mm、20.9 mm、18.2 mm、14.4 mm、17.5 mm和14.1 mm。6组间模拟螺钉长度存在差异(P <；措施)。患者年龄的增加与螺钉长度的增加有中度相关性(r = .397, P <；措施)。结论14mm的螺钉长度在所有年龄和股骨远端区域似乎是安全的，但安全螺钉长度根据年龄和病变位置而变化。后内侧区域的安全长度为18mm。临床意义外科医生在修复小儿膝关节剥离性骨软骨炎病变时必须尊重身体。应通过透视确认螺钉的安全长度，外科医生在使用长度超过14mm（或后内侧18mm）的螺钉时应谨慎，特别是在年轻患者中。

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A Screw Length of 14 mm Is Sufficient to Avoid the Physis During Juvenile Osteochondritis Dissecans Lesion Repair but This Can Vary Based on Age and Region of the Distal Femur

Purpose

To determine the safest screw length that will avoid penetrating the femoral physis for surgical fixation of juvenile osteochondritis dissecans lesions and to compare the safe screw lengths for different regions in the condyles.

Methods

After institutional review board approval, we retrospectively reviewed T1-weighted magnetic resonance images of pediatric patients. Longitudinal axis reference lines were made on the femur. Lines were then placed at 45° anterior and posterior to this axis to simulate screw start points. From these points, we measured the shortest distance from the articular surface to the physis, noting the shortest distances. These measurements simulated screw lengths in the anterior, posterior, and central regions on both the medial and lateral condyle. Statistical analysis was performed to determine the 95% confidence interval for all measurements. Analysis of variance was performed to compare different regions.

Results

A total of 97 knee magnetic resonance images from patients aged 6 to 17 years were reviewed. The safe screw lengths among all samples were 14.1 mm, 20.9 mm, 18.2 mm, 14.4 mm, 17.5 mm, and 14.1 mm for the anteromedial, central medial, posteromedial, anterolateral, central lateral, and posterolateral regions, respectively. There was a difference in simulated screw lengths among all 6 groups (P < .001). There was a moderate correlation between increasing age of the patient and increasing screw length (r = .397, P < .001).

Conclusions

While a screw length of 14 mm appears to be safe in all ages and regions of the distal femur, safe screw length varies based on age and location of the lesion. The posteromedial region has a safe length of 18 mm.

Clinical Relevance

Surgeons must respect the physis when repairing knee osteochondritis dissecans lesions in pediatric patients. Fluoroscopic confirmation should be used to confirm safe screw lengths, and surgeons should use caution when using screws longer than 14 mm (or 18 mm posteromedially), particularly in younger patients.

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