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1、2010级运动人体科学运动损伤与恢复专业方向研究生试卷Anterior cruciate ligament (ACL) 前交叉韧带 Pathophysiology:病理学 The mechanism of ACL injury in the skeletally immature is the same as in adults, with most being noncontact. 在插管对骨未成熟前交叉韧带损伤的机制是成年人，而非接触的大部分相同。 Females have a higher incidence of noncontact ACL injury than their ma
2、le counterparts. 女性具有非接触前交叉韧带损伤比男性的高发病 ACL injuries in this population may be tibial spine bony avulsions as well as ligament tears. 在这一人群的 ACL 损伤可能胫骨骨棘以及韧带撕裂。 ACL injury has been reported in up to 65% of children with acute hemarthrosis. 前交叉韧带损伤据报在小儿急性膝关节积血的 65%。 The presence of open growth plates
3、requires special attention in determining treatment of ACL injuries. 开放的生长板的存在需要特别注意，在确定 ACL 损伤的治疗。Evaluation:评价 History原因 Establish the mechanism of injury. Classic presentation is sudden deceleration or twisting injury with a pop, immediate swelling, and inability to continue playing. 建立损伤的机制。经典的演
4、示文稿是突然减速或扭曲损伤流行，立即肿胀，以及无法继续播放。 Physical examination体格检查 A positive Lachman test is sufficient to make the diagnosis. 积极的拉赫曼测试足以进行诊断。 Evaluate for other associated injuries, including ligamentous injury, patellofemoral instability, and meniscal injury. 其他相关的伤害，包括韧带损伤、 髌股关节不稳和半月板损伤的评估。 Imaging图像描述 Sta
5、ndard four-view x-rays: weight-bearing AP and tunnel; lateral with knee in extension; axial patellar view at 30- or 45- of knee flexion (merchant,sunrise). 标准四视图 x 射线： 负重 AP 和隧道 ；横向扩展 ； 在膝在 30 或 45 的膝关节屈曲 （商人，日出) 的轴向髌骨视图。 MRI is helpful in determining the extent of the ligamentous injury as well as
6、associated injuries such as meniscal tears and chondral lesions. 磁共振成像是有助于确定韧带损伤的严重程度以及相关如半月板和软骨病变的损伤。Treatment:治疗方法 Initial treatment involves ice, compression and restoration of ROM, especially extension (not immobilization) and protected weight bearing. 首次处理涉及冰、 压缩和修复的 ROM，尤其是扩展名 （而不是固定），与保护负重。 T
7、ibial spine ACL avulsions need urgent evaluation for surgery. 胫骨棘撕 ACL 手术需要紧急的评价。 Concern exists regarding surgical management of intrasubstance ACL injuries in adolescents with open growth plates. 关于青少年开放生长板 intrasubstance ACL 损伤的外科治疗存在着关切。 Nonoperative management has shown poor results as activity
8、 modification in adolescents is difficult and bracing provides little or no protection. 非手术治疗已显示业绩不佳，为青少年活动修改是困难和支撑提供很少或没有保护。 Postoperative rehabilitation and RTP criteria are the same as adults. 术后的康复和 RTP 标准是成年人一样。Prevention:预防 Implement a sport-specific conditioning program with periodization (3,
9、4), including these elements that have been shown to have efficacy in specific populations: 实施专项运动调节程序与分期 （3，4），包括这些已显示在特定的人群中有效果的元素： Motor control (including core and lower extremity strength, balance, and flexibility) 电机控制 （包括核心和较低的下肢力量、 平衡和灵活性） Technique training to include landing and sport-spec
10、ific athletic skills programs技术培训，包括升降和专项运动竞技程序 Risk awareness education风险意识教育 Proper care of playing surfaces and selection of shoe wear适当的照顾玩曲面和鞋磨损的选择 No prophylactic bracing has been shown to reduce ACL injury risk. 没有预防性支撑已被证明能减轻 前交叉韧带 损伤的风险。It is essential that the team physician: 至关重要的是，医师团队协作
11、： Understand the classic history and mechanism of ACL injury. 了解经典历史和前交叉韧带损伤的机制。 Perform a Lachman test.执行拉赫曼测试 Understand the poor prognosis of the ACL deficient knee, especially in the adolescent. 了解预后不良的 ACL 缺膝，尤其是在青少年中。 Identify tibial spine ACL avulsions. 确定胫骨棘 ACL。It is desirable that the team
12、 physician: 最好的医师团队协作： Recognize risk of noncontact ACL injury in adolescent female athletes and implement risk reduction strategies through the athletic care network. 认识到在青少年女子运动员的非接触式前交叉韧带损伤的风险和实施减少风险的策略，通过体育保健网络。 Understand that current surgical procedures allow for reconstruction in the skeletal
13、ly immature athlete.了解当前的外科程序允许重建插管对骨未成熟的运动员。 Understand the associated injuries that may accompany or result from ACL instability. 了解相关的伤害可能伴随或从 ACL 不稳定导致。Osteochondritis dissecans (OCD) 强迫性神经官能症Pathophysiology:病理学 OCD is an acquired, potentially reversible idiopathic lesion of subchondral bone res
14、ulting in delamination and sequestration with or without articular cartilageinvolvement and instability. 强迫症是项收购，可能是可逆的特发性病变，软骨下骨中分层和封存有无软骨参与和不稳定造成。 Skeletally immature athletes with an OCD lesion and an intact articular surface have a potential for healing through cessation of repetitive impact loa
15、ding. 强迫症病变与关节表面完整插管对骨未成熟运动员有潜力通过停止加载的反复冲击的愈合。 Skeletally mature athletes with an OCD lesion have a poorer prognosis. 强迫症病变插管对骨成熟运动员有较贫穷的预后。 The presence of mechanical symptoms such as locking or catching may indicate unstable osteochondral fragments. 机械的症状，如锁定或捕捉的存在可能表示不稳定的软骨碎片。Evaluation:评价History
16、原因 Presentation is generally nonspecific and includes poorly localized knee pain.一般非特异性演示文稿，包括差本地化的膝痛。 Establish the presence of mechanical symptoms. 建立机械症状的存在。 Physical examination体格检查 There are no specific physical examination findings for OCD, although pain may be elicited with flexion, extension, internal, and externa
