儿童与青少年胫骨髁间棘撕脱骨折：解剖、治疗策略与重返运动考量的叙述性综述
简介
儿童青少年胫骨髁间棘撕脱骨折是前交叉韧带（ACL）损伤的一种特殊类型，其治疗策略（尤其对部分移位骨折）存在较大异质性。本综述系统总结了该损伤的解剖、生物力学及临床处理要点，指出在特定患者中手术与非手术的重返运动率可能相近，但现有证据多为回顾性、异质性高。早期活动对降低关节纤维化风险至关重要，而重返运动决策多借鉴ACL重建文献，缺乏针对儿童人群的验证，亟需更高…
英文摘要
Tibial spine avulsion injuries represent a distinct pattern of anterior cruciate ligament (ACL) injury in children and adolescents, reflecting the unique anatomical and biomechanical properties of the skeletally immature knee. Unlike midsubstance ACL ruptures, these injuries involve avulsion of the tibial insertion and pose specific diagnostic and therapeutic challenges. Management strategies remain heterogeneous, particularly for partially displaced fractures, with variation in surgical indications, fixation techniques, and rehabilitation protocols. This narrative review provides a structured synthesis of current evidence on the anatomy, biomechanics, clinical presentation, and management of pediatric tibial spine avulsion injuries. Nonoperative and operative approaches are compared, with attention to fixation strategies, complications, physeal considerations, and rehabilitation principles. Return-to-sport (RTS) outcomes are examined, with available evidence suggesting that RTS rates may be comparable between operative and nonoperative management in selected patients, although interpretation is limited by heterogeneous and predominantly retrospective data. Early mobilization appears important for reducing arthrofibrosis risk, while rehabilitation should be individualized. RTS decision-making remains inconsistent, with commonly used criteria largely extrapolated from ACL reconstruction literature and lacking validation in pediatric populations. Multifactorial assessment incorporating functional testing and patient-reported outcomes is increasingly advocated, although evidence for psychological readiness remains limited. Overall, the current literature is characterized by methodological heterogeneity and limited comparative data, restricting definitive conclusions. This review provides a clinically oriented synthesis while highlighting key uncertainties and priorities for future research.