膝关节损伤疼痛：青少年胫骨结节骨骺炎Osgood-Schlatters disease (OSD)

膝关节损伤疼痛：青少年胫骨结节骨骺炎Osgood-Schlatters disease (OSD)

Osgood-Schlatters disease (OSD)

陶可（北京大学人民医院骨关节科）

Patella tendon 髌腱；tibial tubercle 胫骨结节

Patella tendon 髌腱；inflammation 炎症反应

Osgood-Schlatters疾病OSD胫骨结节骨骺炎，典型表现是在膝关节屈曲90度时，可见膝关节胫骨结节处较明显凸起，触痛或叩击痛明显。

儿童期，容易与Osgood-Schlatters胫骨结节骨骺炎相混淆的膝关节疾病：①膝关节急性滑膜炎；②膝关节髌腱炎、髂胫束炎、股四头肌腱炎；③膝关节盘状半月板合并损伤；④剥脱性骨软骨炎OCD、软骨特发性损伤；⑤膝关节感染性疾病，如结核性、化脓炎膝关节炎等，等可能弥漫性或局限于膝关节胫骨结节周围的肿胀、疼痛反应、压痛和叩击痛的临床表现。需经过仔细的病史采集、临床查体以及结合影像学检查判断。

什么是Osgood-Schlatters疾病？胫骨结节骨骺炎

Osgood-Schlatters疾病（OSD）是胫骨结节反复超负荷牵拉造成的骨质炎性反应，是年轻运动员（11-16岁）膝关节疼痛的最常见原因之一。

在OSD中，在胫骨顶部的薄弱生长区有重复的力量，即胫骨结节未完全骨化前，来自髌腱的拉力反复持续地牵拉胫骨结节，进而胫骨结节骨骺产生无菌性炎症反应，导致疼痛和肿胀。

是什么原因导致Osgood-Schlatters疾病？

Osgood-Schlatters疾病（OSD）是由对胫骨结节的重复性过量牵拉引起的，导致该区域受伤。

股四头肌肌肉（大腿肌肉）是人体中最大的肌肉。它附着在膝关节髌骨上，然后由髌韧带附着在胫骨结节（胫骨前方）上。在儿童中，胫骨结节是一个生长区域，由相对较弱的软骨构成。

如果在这个相对较弱的地方（胫骨结节）有过多的牵拉作用力，则会发生损害（胫骨结节骨骺炎）。这种过多的力量可能是由许多因素引起的（跑跳、踢足球、打篮球等）。

在青春期生长过程中，骨骼的生长很快。肌肉不会以与骨骼长大的速度延长，因此可能会变得非常紧张。大腿肌肉（股四头肌）用来拉直膝关节时会产生巨大的力量（例如踢足球）。该力传递到胫骨结节。如果腘绳肌和小腿肌肉紧绷，大腿肌肉必须在与它们“战斗”时更加努力地工作，从而在生长（弱）胫骨结节中造成额外的力量。在运动活跃的儿童中，他们进行了大量的踢脚或跑步，胫骨结节的重复性高强度应力下就会造成损害（胫骨结节骨骺炎）。

如果孩子由于下肢力线不佳（通常是由扁平脚引起的）而导致生物力学差，则下肢的肌肉必须过度努力工作，这可能会导致胫骨结节的应力增加。

Osgood-Schlatters疾病引起了什么问题？（有哪些临床表现）

OSD会导致胫骨结节肿胀，疼痛和压痛。

最初，疼痛可能仅在运动期间或运动后发生。随着问题的恶化，大多数情况下可能出现疼痛。肿胀增加，触摸或敲打（胫骨结节）时痛苦。

这通常会影响在青少年或青少年时期跑跳的男孩。一侧或两侧膝关节可能受到影响。

Osgood-Schlatters疾病如何诊断？

所有医学诊断均应通过完整的病史问诊，检查患者，然后进行综合判断。

这个问题通常发生在经历或刚刚经历成长突飞猛进的男孩中。一侧或两侧膝盖关节可能受到影响。

最初，疼痛可能仅在运动期间或运动后发生。随着问题的恶化，大多数情况下可能出现疼痛。

胫骨结节上可能会肿胀，如果被触摸或敲打，该区域会很痛苦。

必要时，可对患者进行X线片、CT、MRI等影像学检查。

Osgood-Schlatter病如何治疗？

最初的（最重要的）治疗是休息，缓解疼痛并治疗根本原因。

膝关节应休息，以使胫骨结节不断受伤。阻止您的孩子参加运动可能足够，但是有些孩子需要短时间的卧床或沙发平躺休息。让一些孩子休息非常困难，需要使用支具或石膏来减慢他们的（跑跳）速度（限制患者活动，尤其是剧烈运动）。通常建议使用拐杖（必要时）。

OSD通常是由肌肉紧张引起的。通常应遵循伸展计划，通常由物理治疗师监督。拉伸计划每天最多需要进行5次。

如果扁平脚是矫形器（鞋垫），则应使用。

疼痛应由休息（限制活动）和冰敷（每天3-4次结束疼痛区域，急性发作期）来控制疼痛 - 确保皮肤不会冻伤），可以使用简单的止痛药，例如扑热息痛（如美林或泰诺林糖浆）和消炎止疼药（如儿童版-布洛芬混悬液）和乳膏（如扶他林乳膏剂）。

Osgood-Schlatters病通常会随着时间而消失。当您的孩子停止生长时，疼痛和肿胀应该消失，因为胫骨结节的增长（薄弱）并变成坚固的骨骼。

我孩子的膝关节要花多长时间才能变得更好？

疼痛可能需要几周或几个月的时间才能完全停止。当疼痛完全消失时，您的孩子可能会慢慢回到他或她以前的活动水平。

我的孩子可以做些什么来防止发生Osgood-Schlatters？

①重要的是要在锻炼前后进行正确的热身和停止活动。这应该包括预伸展活动。

②可能有必要在运动之外进行额外的伸展运动，尤其是在增长阶段。

③您应该避免您的孩子只参加一项体育运动。

④你不应该让你的孩子在疼痛中玩耍。

WHAT IS OSGOOD-SCHLATTERS DISEASE?

Osgood-Schlatters disease (OSD) is a traction apophysitis of the tibial tubercle and is one of the commonest causes of knee pain in young athletes.

In OSD there is repetitive excessive force (pull) on the weak growing area at the top of the shin bone causing pain and swelling.

WHAT CAUSES OSGOOD-SCHLATTERS DISEASE?

Osgood-Schlatters disease (OSD) is caused by repetitive excessive force to the tibial tubercle, causing injury to this area.

The quadriceps muscle (thigh muscle) is the largest muscle in the human body. It is attached to the patella (kneecap) and this in turn is attached to the tibial tubercle (front of the shin bone) by the patella ligament. In children, the tibial tubercle is a growing area and is made of relatively weak cartilage.

If there is excessive force at this relatively weak point, damage occurs. This excess force can be caused by a number of factors.

During the adolescent growth spurt the bones grow very quickly. The muscles do not lengthen at the same rate as the bone grows, and so can become very tight. The thigh muscles generate huge forces when they are used to straighten the knee (such as kicking a football). This force is transmitted to the tibial tubercle. If the hamstring and calf muscles are tight , the thigh muscles have to work even harder as they “fight ” against them, causing extra force at the growing (weak) tibial tubercle. In active children, who undertake a lot of kicking or running, the repetitive high force at the tibial tubercle causes damage.

身高随年龄增长关系；每年身高生长高度与年龄增长关系：揭示了为何Osgood-Schlatters为何好发生在11-16岁男性患儿。

If a child has poor biomechanics due to poor lower limb alignment (often caused by flat feet), the muscles of the lower limb have to work excessively hard and this can cause increased force at the tibial tubercle.

WHAT PROBLEMS DOES OSGOOD-SCHLATTERS DISEASE CAUSE?

OSD causes swelling, pain and tenderness over the tibial tubercle.

Osgood-Schlatters胫骨结节骨骺炎好发生于违法与成熟的膝关节胫骨结节处，以红肿、炎症疼痛反应、压痛和叩击痛为主要临床表现。

Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time. The swelling increases and is painful when touched or knocked.

It commonly affects boys who are having a growth spurt during their pre-teen or teenage years. One or both knees may be affected.

HOW IS OSGOOD-SCHLATTERS DISEASE DIAGNOSED?

All medical diagnosis should be made by taking a full history, examining the patient then performing investigations.

The problem usually occurs in boys who are going through or have just gone through a growth spurt; one or both knees may be affected.

Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time.

There may be swelling over the tibial tubercle and this area is painful if touched or knocked.

HOW IS OSGOOD-SCHLATTER DISEASE TREATED?

The initial treatment is rest, relieve the pain and treat the underlying cause.

The knee should be rested so that the tibial tubercle it is not being continually “injured”. It may be sufficient to stop your child playing sport but some children require a short period of bed or couch rest. Some children find resting very difficult and require the use of braces or plasters to slow them down. Using crutches is often advised.

OSD is usually caused by tight muscles. A stretching program should be followed usually supervised by a physiotherapist. The stretching program may need to be undertaken up to 5 times a day.

If flat feet are a problems orthotics (insoles) should be used.

The pain should be controlled by rest (limiting activity) and ice (icing the painful area 3-4 times a day – making sure the skin is not burnt), Simple pain killers can be used such as paracetamol as well as anti-inflammatory tablets and cream.

Osgood-Schlatters disease usually goes away with time. When your child stops growing, the pain and swelling should go away because the growing (weak) tibial tubercle fuses and becomes solid bone which is very strong.

HOW LONG WILL IT TAKE FOR MY CHILD’S KNEE TO GET BETTER?

It may take several weeks or months for the pain to completely stop. When the pain is completely gone, your child may slowly return to his or her previous level of activity.

WHAT CAN MY CHILD DO TO HELP PREVENT DEVELOPING OSGOOD-SCHLATTERS?

It is important to undertake correct warm ups and warm downs before and after exercise. This should include a stretching routine.

It may be necessary to undertake additional stretching outside of sport, especially during stages of growth.

You should avoid your child only playing one sport.

You should not allow your child to play through pain.