骨骼未成年人的交叉韧带体部完全断裂的修复方法

未成年人交叉韧带重建CruciateLigamentReconstructioninSkeletallyImmaturePatients广东省中医院二沙岛分院骨科许树柴黄泽鑫为什么要重建未成年人完全断裂的前交叉？循证医学证据 1.半月板损伤meniscusinjury 2.软骨损伤cartilagedamage 3.保守治疗是无赖之举 4.儿童/少年制动是一件难事All-EpiphysealAnteriorCruciateLigamentReconstructioninSkeletallyImmaturePatients:ASurgicalTechniqueUsingaSplitTibialTunnelManytechniqueshavebeendescribedforanteriorcruciateligament(ACL)reconstructioninskeletallyimmaturepatientsincludingphyseal-sparingtechniques（骨骺保护技术）,Andextra-articular（关节外技术）,completeorpartialtransphyseal（通过骨骺技术）,MariosG. Lykissas,M.D.,Ph.D.,AddresscorrespondencetoEricJ.Wall,M.D.,DivisionofOrthopaedicSurgery,CincinnatiChildren'sHospitalMedicalCenter,3333BurnetAve,MLC2017,Cincinnati,OH45229,U.S.A.Anall-epiphysealquadruple-hamstringACLreconstructionusingasplittibialtunnel.全骨骺内，股薄肌/半腱肌分开通过胫骨隧道Thesplittibialtunnelsdropthetunnelsizedownto4.5to5.5mmbecauseonlyhalfthetotalgraftdiameterpassesthrougheachofthesplittunnels.Thisincreasesthesafetymarginforkeepingthetunnelwithinthetibialepiphysis,inadditiontoavoidingdamageintothegrowthplate.Modifiedall-epiphysealACLreconstruction.(A)Afemoraltunnelandasplittibialtunnelareplacedentirelywithinthedistalfemoralandproximaltibialepiphysis,respectively.(B)Abiocompositeinterferencescrew(Matryx)isusedtofixthegraftintothefemoraltunnel.A1-cmbonebridgebetweenthe2tibialtunnelsismaintained.(C)中间1CM的骨桥保护Lateralillustrationoftheall-epiphysealtechniqueshowingthecorrectpositionofthefemoraltunnelinthelateralplane,aswellastheloopedendofthegraftaroundtheanteromedialtibialepiphysis.Graftpreparationinall-epiphysealACLreconstructionwithsplittibialtunnel.TheproximalendofthegracilisissewntothethindistalendofthesemitendinosuswithawhipstitchandviceversabyuseofNo.2FiberLoopsutures.(两端缝合，中央不缝)Thecentral12cmofthedoubledgraftisleftfreeofsuture.Thedoubledtendonsarefoldedover,andVicrylsutureisloopedaroundthemidpointofthegraft.Thetendonsarethenplacedunder10lboftensionfor20minutesonthebacktablewiththeuseoftheGraftMasterdevice.中央12CM不缝合。 Tibialtunnelpreparationinall-epiphysealACLreconstructionwithsplittibialtunnel.(A).Thefirsttibialguidewireisdrilledintotheepiphysisunderfluoroscopicguidancewhiletheprobeisusedfortriangulation（三角）.(B)Arthroscopicviewofthesamekneethroughtheanterolateralportal.Oneshouldnotethatthetipoftheprobeisplacedatthedesiredexitpointoftheguidewire.(C)Arthroscopicviewofthesamekneethroughtheanterolateralportal.ThetipoftheguidewireisvisualizedarthroscopicallywhileenteringthekneejointatthemedialaspectoftheACLfootprintatthelevelofthefreeedgeofthelateralmeniscus.Tibialtunnelpreparationinall-epiphysealACLreconstructionwithsplittibialtunnel:lateralradiograph(A)andarthroscopicviewthroughtheanterolateralportal(B).Itshouldbenotedthatthesecondtibialguidewireisplacedinaconvergent（趋集于一点）waytothefirsttibialpin. Tibialtunnelpreparationinall-epiphysealACLreconstructionwithsplittibialtunnel:lateralradiographoftheleftkneeofa9-year-oldboywithacompletemidsubstanceACLtear.胫骨隧道准备，9岁的男孩，ACL体部全断裂，术中X机透视Tibialtunneldrillingbeginswiththelateraltibialtunnelafterthemedialguidewirehasbeenpulledback.Femoraltunnelpreparationinall-epiphysealACLreconstructionwithsplittibialtunnel:lateralradiographoftheleftkneeofa9-year-oldboywithacompletemidsubstanceACLtearafterdrillingofthefemoraltunnel.一个9岁的前交叉韧带全断裂的男孩，C臂机证实股骨定位点及隧道未损伤生长板Graftretrievalinall-epiphysealACLreconstructionwithsplittibialtunnel:arthroscopicviewthroughtheanterolateralportal.Oneshouldnotethe2graftlimbslyingattheintra-articularendofthefemoraltunneljustbeforetheirsimultaneousadvancementintothefemur.The2tibialtunnelsshareacommonexitpointatthearticularsurfaceofthetibia.Inyoungchildrenthespaceavailablefordrillingislimitedbecauseofthepresenceofthegrowthplate.Thusthisisasplit–tibialtunneltechniquewithoutbeingadouble-bundleACLreconstructionatthesametime.这是一个胫骨隧道分开技术，但并不是一个双束双隧道技术Advantages,Risks/Limitations,Tips,andPearlsofAll-EpiphysealACLReconstructionUsingSplitTibialTunnel栓系 Advantages Risks/Limitations Tips技巧 Pearls Avoidsdrillingthroughthegrowthplate Growthplateinjuryfrominadequatetibialtunneldrilling Starttheskinincisionforgraftharvestingjustbelowthejointlinetofacilitatedrillingofthetibialepiphysealtunnels Donottrytogainextratendonlengthbystripping剥theperiosteumbecausethismaystimulatemedialovergrowthoftheproximaltibia刺激胫骨近端内侧过度生长 Avoidstetheringthegrowthplate Limbovergrowthduetostimulationofthephyses(hypervascularityduetodrillingnearphyses)肢体的过度生长 PerformaminimalnotchplastytoallowadequatevisualizationoftheanatomicACLfootprintonthefemur Sewthethickproximalendofthegracilistothethindistalendofthesemitendinosusandviceversa粗细搭配，直径一致 Minimizestheriskofpermanentgrowtharrest Surgerythroughtheperiosteumnearthetibialphysismayalsostimulategrowth Duringgraftretrieval,pullthegraftlimbsthroughthefemoraltunnelsimultaneously Avoidsuturesatthecentral12cmofthedoubledgraft中间不要用线去缝合，可能影响骨骺生长 Restorestheisometry等距byanatomicgraftplacement Fixthegraftin30°offlexion Donotreamthefemoraltunneluntilthetibialtunnelsareplaced先准备好胫骨隧道，然后才钻股骨隧道，因为胫骨隧道可能失败。 Minimizestheriskofcartilagedamagefromrecurrentkneeinstability Ifthereisadifferenceinthediameterofthelimbsofthegraft,thesmallestdrillshouldbeusedforreamingthemedialtibialtunnel。注意最小化直径，与供体一致 Thedecreaseddiameterofthetibialtunnelsincreasesthesafetymarginforkeepingthetunnelswithinthetibialepiphysis Ensurethata1-cmbonebridgewillremainbetweenthe2tunnelsafterreaming中央保证1CM骨桥 Thebonebridgebetweenthe2tibialtunnelsservesasasolidlow-profilefixationpost Afteradvancingthegraft,thesutureloopthathadbeenplacedatthecenterofthegraftduringpreparationshouldoverliethecenterofthetibialbonebridgeTable2.IndicationsandContraindicationsofAll-EpiphysealACLReconstructionUsingSplitTibialTunnel全骨骺内分叉技术的适宜症与反指征 Indications Contraindications Boyswithamidsubstance（体部实质）ACLtearandaboneage≤14.5yrwhowishtoreturntocuttingsports Childrenwhostrictlyavoidcuttingsportsanddonothaverecurrentkneeinstabilityepisodes（不要有复发的膝关节不稳） Girlswithamidsubstance（体部实质）ACLtearandaboneage≤13yrwhowishtoreturntocuttingsports Skeletallyimmatureathleteswithboneages>14.5yrforboysand>13yrforgirls年龄大于14.5岁的男孩/13岁的女孩运动员Video1. Theall-epiphysealACLreconstructionbeginswiththeinsertionofa2.4-mmguidepinpercutaneouslythroughthelateralfemoralcondylefromoutsideinwiththeArthrexfemoralcobraRetroDrillguide.Theaccuratepositionoftheguidepinisconfirmedfluoroscopicallyinbothanteroposteriorandlateralplanes.Thefemoraltunnelisreamedovertheguidepinwithanappropriate-sizedrill.Thefirsttibialguidepinisdrilledintotheepiphysisunderfluoroscopicguidancewhiletheprobeisusedfortriangulation.Asecondguidepinisplacedabout1.5cmmoremediallyintheproximaltibialepiphysisanddirectedsothatitconvergeswiththefirstguidepin.Thesecondguidepinisalsodrilledwithintheepiphysis.Theaccuratepositionofbothguidepinsisconfirmedfluoroscopically,andthetibialtunnelsarereamed.Byuseof2looped22-gaugewiresthatareplacedthroughthefemoraltunnelandretrievedthroughthetibialtunnels,theindividualdoubledgraftlimbsareadvancedindependentlythroughthetibialtunnelstotheintra-articularendofthefemoraltunnel.Then,thegraftlimbsarepulledupthroughthefemoraltunnelsimultaneously,andthegraftisfixedwithaMatryxbiocompositeinterferencescrewwhilethekneeispositionedinapproximately30°offlexion.手术操作视频All-EpiphysealAnteriorCruciateLigamentReconstructionAll-Epiphyseal,All-InsideAnteriorCruciateLigamentReconstructionTechniqueforSkeletallyImmaturePatientsThegraftisaquadrupledsemitendinosusautograftsecuredwith2TightRopeRTdevicesintheGraftLinktechnique.Graftlengthisbetween50and55mm,withadiameterbetween7and8mm.Thegraftistensionedat20lbfor5minutes.MoiraM. McCarthy,M.D.AddresscorrespondencetoMoiraM.McCarthy,M.D.,HospitalforSpecialSurgery,535E71stSt,NewYork,NY10021,U.S.A.Thefemoralfootprint股骨韧带足迹isdebridedwhilethesurgeonisviewingwitharthroscopesusingboth70°and30°lensesfromtheanterolateralportal.Thisisaviewusingthe70°lens.Thetunnelisplannedforthecenterofthefemoralfootprint,approximately2to3mmfromthebackwall.(B)Thetunnelisdrilledbyfirstplacingtheoutside-infemoralguidethroughtheanterolateralportal.Oncetheappropriatepositionisverifiedbyfluoroscopy,theFlipCutterisopenedandthetunnelisdrilledretrogradewhilethesurgeonisviewingwitheithera30°or70°arthroscopefromtheanteromedialportal.(C)Thetunnel,viewedfromtheanterolateralportal,withabonebridgetothelateralcortexofatleast7mm,istaggedwithaFiberStickforlatergraftpassage.特殊的操作工具，从关节内向关节外钻隧道，保证皮质7MM厚度。Thetibialfootprint,asviewedthroughtheanterolateralportalwitha70°arthroscope,isdebrided.Thetunnelisplannedforthecenterofthetibialfootprint.Again,theFlipCutterisdrilledfromoutsideincompletelywithintheepiphysis.Onceappropriatepositionisconfirmedbyfluoroscopyontheanteroposteriorandlateralviews,theFlipCutterisopenedandthetunnelisdrilledantegrade.(B)Viewsofthetibialtunnelfromtheanterolateralportalusinga70°arthroscope.Theguideismalleted球棍throughthecortextoensureabonebridgeofatleast7mmbetweenthegraftandthesuturebutton.特殊的操作工具，从关节内向关节外钻隧道，保证皮质7MM厚度。Viewsofintra-articularportionofall-epiphysealACLreconstructionfromanterolateralportal.Radiographsofall-epiphysealACLreconstructionandfixationwithGraftLinkRT.SportsMedArthroscRehabilTherTechnol. 2011; 3:7.Publishedonline2011April8. Anteriorcruciateligamentreconstructionusingquadricepstendonautograftforadolescentswithopenphyses-atechnicalnoteChristianMauch,1 MarkusP骨骺保护技术BackgroundOnemajorconcerninthetreatmentofACLlesionsinchildrenandadolescentswithopenphysesistheriskofiatrogenicdamagetothephysesandapossiblyresultinggrowthdisturbance.PurposeTheprimarypurposeofthisarticleistodescribeourtechniqueofatransphysealACLreconstructionusingquadricepstendon-boneautograftinchildrenandadolescentswithopengrowthplates.Thesecondaryaimistoreportourearlyresultsintermsofpostoperativegrowthdisturbanceswhichareconsideredtobeamajorconcerninthischallenginggroupofpatients.Itwasourhypothesisthatwithourproposedtechniquenosignificantgrowthdisturbanceswouldoccur.ConclusionsThedescribedACLreconstructiontechniquerepresentsapromisingalternativetopreviouslydescribedproceduresinthetreatmentofchildrenandadolescentswithopengrowthplates.Usingquadricepstendonfuturegraftavailabilityisnotcompromised,asthemostfrequentlyusedautograft-source,ipsilateralhamstringtendons,remainsuntouched.SchematicdrawingofanexampleofaphysealsparingACLreconstructiontechniqueinpatientswithopenphyses.骨骺开放的骨骺保护技术，隧道重建技术Transphysealtechniques,establishtheirtibialand/orfemoraltunnelsbytransphysealdrilling,andareeithernamedaspartial(onlytibial)orcomplete(tibialandfemoral)dependentwhetheralloronlyonephysesisdrilledthroughChoteldescribedapartialtransphysealtechniqueusingquadricepstendonautograftbeingplacedextraarticularunderthelateralfemoralcondyleandattachedintraarticularthroughatransphysealtibialtunnelwhichleavesthefemoralphysisuntouchedAtleast7cmlongquadricepstendonautograftisharvested,shapedandthenarmedwithtwononresorbablesuturesontheboneandtendonend.IntraoperativearthroscopicimagesoftheproposedtransphysealsurgicalACLreconstructiontechniqueusingquadricepstendonautograftinpatientswithopenphyses.ATheintercondylarnotchandfemoralattachmentareaswerecleanedusingashaverblade. IllustrationshowingthedescribedtransphysealsurgicalACLreconstructiontechniqueusingquadricepstendonautograftinpatientswithopenphyses.PostoperativetreatmentAnearlyfunctionalrehabilitationprogramwithpassiverangeofmotiontraining,electricalmusclestimulationandclosedchainquadricepsandhamstringexerciseswasinitiated.Foramaximumoftwoweeksambulationwithfullweightbearingwasonlyallowedinfullextension.Passiverangeofmotiononacontinuouspassivemotionmachinewasinitiatedondayoneaftersurgery.During8weeksthepatientwasmobilisedinanextensionbrace.Sportsactivitywasinitiated6monthspostoperatively,cuttingandpivotingsportninemonthspostoperatively.术后康复计划 PatrickN.Siparsky和MininderS.Kocher教授认为，由于未成年人较差的依从性，对于未成年人的手术治疗，康复计划的完善化尤为重要 对于术后康复计划ChristianMauch教授的做法是，早期的机能康复治疗包括被动型的运动训练、肌肉电刺激以及股四头肌和腘绳腱的闭链运动。最多两个星期内，关节在完全伸展的情况下开始进行全负重的主动活动，如下蹲和站立。手术后的第一天就要求开始在持续的被动运动机上进行被动康复运动，8周内动员病人用支撑架进行活动，手术后六个月开始开展运动，手术后九个月开始剧烈运动和旋转运动。ProgressivevalgusandflexiondeformityofapatientafterQTACLreconstructionandafterdistalfemoralvarisationosteotomy.儿童膝关节韧带重建后发生外翻及屈曲畸形，髁上截骨矫形。Theearlylocalizedgrowthstopwasattributedtoamalplacementoftheautograftboneblockwithinthefemoralposterolateralepiphysealplate.Thefemoralboneblockwasplacedtohighinthenotchdamagingthefemoralgrowthplate.并发症未成年人的前交叉韧带重建术主要的并发症在于半月板及骨骺的损伤，从而造成的生长抑制和成角畸形。并发症主要包括，移植物的固定装置过于靠近或穿过骨骺，隧道没有被移植物充分的填充而形成骨桥，隧道位置不正等。P.Vavken和M.M.Murray统计了47篇符合要求的文献，共585位前交叉韧带重建术后的未成年患者得到至少6个月的随访，其中479位患者采用了至少1个跨骨骺型隧道的方法，有3位患者出现了成角畸形，2位患者出现双下肢不等长。另外106名患者采用了骨骺保护型重建术，并没有发现有生长障碍。1.0骨骺保护技术InvestigationperformedattheDivisionofSportsMedicine,DepartmentofOrthopaedicSurgery,Children'sHospital,HarvardMedicalSchool,Boston,MassachusettsTheoriginalscientificarticleinwhichthesurgicaltechniquewaspresentedwaspublishedinJBJSVol.87-A,pp.2371?379,November2005MininderS.Kocher,MD,MPHmininder.kocher@childrens.harvard.eduSumeetGarg,MDDepartmentofOrthopaedicSurgery,WashingtonUniversityOrthopaedicResidencyProgram,OneBarnesHospitalPlaza,St.Louis,MO63110JBoneJointSurg[Am]2006;88-A;283-932.0关节外技术BACKGROUND:Themanagementofanteriorcruciateligamentinjuriesinskeletallyimmaturepatientsiscontroversial.Conventionaladultreconstructiontechniquesriskpotentialiatrogenicgrowthdisturbanceduetophysealdamage.Thepurposeofthisstudywastoevaluatetheresultsofaphysealsparing,combinedintra-articularandextra-articularreconstructiontechniqueinprepubescentskeletallyimmaturechildren.METHODS:Between1980and2002,forty-fourskeletallyimmatureprepubescentchildrenandadolescentswhowereinTannerstage1or2(withameanchronologicalageof10.3years)underwentphysealsparing,combinedintra-articularandextra-articularreconstructionoftheanteriorcruciateligamentwithuseofanautogenousiliotibialbandgraft.Twenty-sevenpatientshadadditionalmeniscalsurgery.Functionaloutcome,graftsurvival,radiographicoutcome,andgrowthdisturbancewereevaluatedatameanof5.3yearsaftersurgery.CONCLUSIONS:Physealsparing,combinedintra-articularandextra-articularreconstructionoftheanteriorcruciateligamentwithuseofanautogenousiliotibialbandgraftinskeletallyimmatureprepubescentchildrenandadolescentsprovidesexcellentfunctionaloutcomewithalowrevisionrateandaminimalriskofgrowthdisturbance.2.0关节外技术INDICATIONS:Acompletemidsubstancetearoftheanteriorcruciateligamentinaprepubescentchild(Tannerstage1or2)forwhomnonoperativetreatmentconsistingofrehabilitation,bracing,andactivityrestrictionhasfailed().Thesepatientshavesymptomsrelatedtokneepivotingorfurthermeniscalorchondralinjuryrelatedtoinstability.CONTRAINDICATIONS:Pubescentadolescents(Tannerstage3).Suchpatientsshouldbetreatedwithtransphysealreconstructionwithautogenoushamstringtendonsandfixationawayfromthegrowthplate().Proximaltearsoftheanteriorcruciateligament,whichareamenabletoprimaryrepair,anddistaltibialspinefractures,whicharetreatedwitharthroscopicreductionandinternalfixation.childwhowillnotcooperatewithpostoperativerehabilitation.PITFALLS:Failuretoadequatelyassessthestageofgrowthanddevelopmentofthepatient.Inadditiontochronologicalage,skeletalageshouldbedeterminedfromahandandwristradiographandtheTannerstageshouldbedeterminedbythephysicianorthepatientonthebasisofachart.Harvestinganiliotibialbandgraftofinsufficientlength.Thiscanbeavoidedbyusingasufficientlylongincision,usingatendonstripper,ormakingacounterincisionproximallyinthethigh.DetachmentoftheiliotibialbandfromGerdy'stubercle.Whenthegraftisdissecteddistally,careshouldbetakentonottransectitjustproximaltoGerdy'stubercle.Vigorousnotchplastyorover-the-top-positiondissection.Thiscanresultinphysealinjurysincetheperichondrialringisincloseproximity().Failuretobringthegraftundertheintermeniscalligamentorchamferingofagrooveintheproximaltibialepiphysisundertheintermeniscalligament,whichcanresultinamoreanteriorandhorizontalgraftplacementthendesired.Inadequatetibialfixation.Suturefixationtoatroughwithintheperiosteumisusuallysufficient;however,thiscanbesupplementedwithastapleorascrewandpost.Prolongedcastimmobilization,whichcanleadtostiffnesspostoperatively.ACL的关节外技术示意图，骨骺保护技术，髂胫束SchematicdrawingofanexampleofanextraarticulartechniqueforACLreconstructioninpatientswithopenphyses.PhysealsparingtechniquessuchasdescribedbyAndersonremainthephysesuntouchedavoidingtransphysealtunneldrillingbutarerarelyreported。儿童后交叉韧带重建Anadolescentpatientwithposteriorinstabilityandposterolateralinstabilityofthekneeforwhomnonoperativetreatmenthadfailedandwhowassuccessfullytreatedwithuseofaphysealsparingintra-articularreconstructionoftheposteriorcruciateligamentandanextra-articularreconstructionoftheposterolateralstructures.3.0通过骺板的方法 KOCHER,MININDERS.,MD, InvestigationperformedattheDivisionofSportsMedicine,DepartmentofOrthopaedicSurgery,Children'sHospital,HarvardMedicalSchool,Boston,Massachusetts MininderS.Kocher,MD,MPHDivisionofSportsMedicine,DepartmentofOrthopaedicSurgery,Children'sHospital,300LongwoodAvenue,Boston,MA02115.E-mailaddressforM.S.Kocher:mininder.kocher@childrens.harvard.edu Background:Managementofanteriorcruciateligamentinjuriesinskeletallyimmaturepatientsiscontroversial.Conventionalsurgicalreconstructiontechniquesforadultscancauseiatrogenicgrowthdisturbanceduetophysealdamageinchildren.Thepurposeofthisstudywastoevaluatetheresultsofatransphysealreconstructiontechniqueinpubescentbutskeletallyimmatureadolescents. Methods:Between1996and2004,sixty-onekneesinfifty-nineskeletallyimmaturepubescentadolescents(Tannerstage3)withameanchronologicalageof14.7years(range,11.6to16.9years)underwenttransphysealreconstructionoftheanteriorcruciateligamentwithuseofanautogenousquadrupledhamstrings-tendongraftandmetaphysealfixation.Thirty-onekneeshadadditionalmeniscalsurgery.Thefunctionaloutcome,graftsurvival,radiographicoutcome,andanygrowthdisturbancewereevaluatedatameanof3.6years(range,2.0to10.2years)afterthesurgery. Results:Twopatients(3%)underwentrevisionanteriorcruciateligamentreconstructionbecauseofgraftfailureatfourteenandtwenty-onemonthspostoperatively.Fortheremainingfifty-nineknees,themeanInternationalKneeDocumentationCommitteesubjectivekneescore(andstandarddeviation)was89.5?10.2pointsandthemeanLysholmkneescorewas91.2?10.7points.TheresultoftheLachmanexaminationwasnormalinfifty-onekneesandnearlynormalineight;itwasnotabnormalorseverelyabnormalinanyknee.Theresultofthepivot-shiftexaminationwasnormalinfifty-sixkneesandnearlynormalinthreeknees;italsowasnotabnormalorseverelyabnormalinanyknee.Themeanincreaseintotalheightwas8.2cm(range,1.2to25.4cm)fromthetimeofsurgerytothetimeoffinalfollow-up.Noangulardeformitiesofthelowerextremityweremeasuredradiographically,andnolower-extremitylengthdiscrepanciesweremeasuredclinically.Complicationsincludedthreecasesofarthrofibrosisrequiringmanipulationwiththepatientunderanesthesia. Conclusions:Transphysealreconstructionoftheanteriorcruciateligamentwithuseofanautogenousquadrupledhamstrings-tendongraftwithmetaphysealfixationinskeletallyimmaturepubescentadolescentsprovidesanexcellentfunctionaloutcomewithalowrevisionrateandaminimalriskofgrowthdisturbance.阴茎睾丸乳晕阴唇乳房萌芽腋毛与座疮未成年人交叉韧带重建一定要知道Tannerstage分期Stage2，7-8岁，骨骺保护技术，或关节外技术？Stage413岁，骨骺通过/兼骨骺保护Stage5满16岁，正常成人方式Tanner分期 Tanner分期是根据未成年人的外貌特征用于评估未成年人生长发育状态的一项。不少文献了在决定未成年人前交叉韧带重建的手术方式前，Tanner分期（Tannerstage）在临床的参照价值，Tanner分期具体如下： 对于男性，Tanner1期：1、身高生长速率为5-6厘米/年；2、有青春期前的外观；3、睾丸体积小于1.5ml；4、阴茎直径在3厘米或更小。 Tanner2期：1、身高生长速率为5-6厘米/年；2、阴茎根部和阴囊有少量绒毛似的毛；3、阴囊皮薄；4、睾丸长大至6ml；5、阴囊的生长开始；6、阴茎大小不变 Tanner3期：1、身高生长速率为7-8厘米/年；2、开始出现阴毛的变粗变黑；3、阴毛开始从阴茎上扩展到一个三角区域或更大的区域；4、睾丸大小在6-12ml；5、阴囊继续长大；6、阴茎开始长大，首先是宽度，然后是长度；7、由于激素分泌，70%的人会暂时发育胸部。 Tanner4期：1、身高生长速率为10厘米/年；2、阴毛质地类似成人，但未扩展到腿部；2、睾丸大小约12-20ml；3、阴囊持续长大；4、阴囊颜色开始变深；5、阴茎持续长大，首先是长度增长至约10厘米，然后是宽度；6、由于激素分泌，70%的人会暂时发育胸部。 Tanner5期：1、身高已停止生长；2、阴毛蔓延至大腿内侧；3、睾丸大小为18-20ml或更大；4、阴囊为成年人大小，且颜色变深；5、阴茎长度约15cm；6、若有乳房增大的，开始回复。 对于女性，Tanner1期：1、身高生长速率为5-6厘米/年；2、完全没有阴毛3、青春期前的外观；4、未出现乳腺组织；5、乳晕还未显现出胸前的皮肤。 Tanner2期：1、身高生长速率为7-8厘米/年；2、大阴唇开始出现少量长茸毛发；3、乳房芽形成；4、小区域的腺状组织出现；5、乳晕开始变大。 Tanner3期：1、身高生长速率为8厘米/年；2、阴毛变黑，变卷，变粗；3、阴毛开始蔓延到前面和两侧；4、乳房开始突出，5、乳房的发育范围超出乳晕。 Tanner4期：1、身高生长速率为7厘米/年；2、阴阜上有成人一样的阴毛，但未蔓延至大腿上段；3、胸部变大、变挺；4、乳晕二次发育扩展到