膝关节脱位的早期诊断及微创治疗方法

doi:10.13418/j.issn.1001-165x.2017.05.016

Abstract

Abstract:

Objective　To investigate the early diagnosis and minimally invasive treatment of knee dislocation.　Methods　Retrospective analysis of 90 cases of traumatic knee dislocation from July 2011 to October 2015 were performed. Arthroscopic reconstruction of the ligament was performed, the joint capsule was not repaired and the popliteal artery was repaired for 3 weeks. If the calf muscles have necrosis, then the tibialis tendon or Achilles tendon was used for ligament reconstruction nerve exploration, release or suture surgery was carried out. Lysholm knee score was adopted for evaluation of the knee function before and after surgery. 　Results　Of the 90 patients, 78 were followed up for an average of 18 months (9 to 24 months). The Lysholm score for the last follow-up knee function was 78 to 91, with an average of 85.6 points. 75 cases of drawer test and Lachman test was Ⅰ° positive, and all of the internal and external tests were negative; 3 cases of calf muscle underwent necrosis caused by popliteal artery injury: a Ⅱ° relaxation in 1 case, Ⅲ° relaxation in 2 cases.　Conclusion　Physical and imaging examinations have a positive effect on the diagnosis of traumatic knee dislocation. The one-stage reconstruction of knee ligament injury is feasible, which can lead to a satisfactory short-term curative effect.

Key words: Knee, 　Dislocation, 　Arthroscopy；　Cruciate ligament, 　Repair and reconstruction

LIU Hai-long, DING Jing, GAN Yu-dong. The early diagnosis of knee dislocation and its minimally invasive treatment methods[J]. Chinese Journal Of Clinical Anatomy, 2017, 35(5): 559-563.

References

[1] Streubel PN, Arndt S, Armitage MS. Fatal knee dislocation in a morbidly obese Jehovah’s Witness: a case report [J]. Obes Surg, 2010, 20(9):1316-1318.
[2] Shetty RR, Mostofi SB, Housden PL. Knee dislocation of a morbidly obese patient: a case report [J]. Orthop Surg (Hong Kong), 2005, 13(1):76-78.
[3] Shelbourne KD, Porter DA, Clingman JA,et al. Low-velocity knee dislocation [J]. Orthop Rev, 1991, 20(11):995-1004.
[4] 王亦璁, 陈扬. 对膝关节外伤性脱位的再认识[J], 中华骨科杂志, 1999, 19(2):629-632.
[5] Robertson A, Nutton RW, Keating JF. Dislocation of the knee [J]. Bone Joint Surg Br, 2006, 88(6):706-711.
[6] Keating JF. Acute Knee Ligament Injuries and Knee Dislocation [J]. European Surgical Orthopaedics and Traumatology, 2014, 22(8):2949-2971.
[7] Wascher DC. High-velocity knee dislocation with vascular injury [J]. Treatment and principles [J]. Clin Sports Med, 2000,19(5):457-477.
[8] Brautigan B, Johnson DL. The epidemiology of knee dislocations [J]. Clin Sports Med, 2000, 19(3):387-397.
[9] Sillanpää, PJ. Kannus, P,Niemi, ST, et al. Incidence of knee dislocation and concomitant vascular injury requiring surgery: A nationwide study [J]. Journal of Trauma and Acute Care Surgery, 2014, 76(3):715-719.
[10]Kennedy JC. Complete dislocation of the knee joint [J]. J Bone Joint Surg Am. 1963;45:889-904.
[11]Merritt AL, Wahl C. Initial assessment of the acute and chronic multiple-ligament injured (dislocated) knee [J]. Sports Med Arthrosc, 2011, 19(2):93-103.
[12]Meyers MH, Harvey JP. Traumatic dislocation of the knee joint: a study of eighteen cases [J]. J Bone Joint Surg Am, 1971, 53(1):16-29.
[13]Meyers MH, Moore TM, Harvey JP. Traumatic dislocation of the knee joint [J]. J Bone Joint Surg Am, 1975, 57(3):430-433.
[14]Green NE, Allen BL. Vascular injuries associated with dislocation of the knee [J]. J Bone Joint Surg Am, 1977, 59(2):236-239.
[15] Hagino RT, DeCaprio JD, Valentine RJ. Spontaneous popliteal vascular injury in the morbidly obese [J]. J Vasc Surg, 1998, 28(3):458-462.
[16]Shelbourne KD, Haro MS, Gray T. Knee dislocation with lateral side injury: results of an en masse surgical repair technique of the lateral side [J]. Am J Sports Med, 2007, 35(3):1105-1117.
[17]Chhabra A, Cha PS, Rihn JA,et al. Surgical management of knee dislocations [J]. J Bone Joint Surg Am, 2005, 87(1 suppl 1):1-21.
[18] McCoy GF, Hannon DG, Barr RJ. Vascular injury associated with low-velocity dislocations of the knee [J]. J Bone Joint Surg Br, 1987, 69(2):285-287.
[19]McDonough EBJr, Wojtys EM. Multiligamentous injuries of the knee and associated vascular injuries [J]. Am J Sports Med, 2009, 37(1):156-159.
[20]Merrill KD. Knee dislocations with vascular injuries [J]. Orthop Clin North Am, 1994, 25(4):707-713.
[21]Cho D, Saetia K, Lee S, et al. Peroneal nerve injury associated with sports-related knee injury [J]. Neurosurg Focus, 2011, 31(5):E11.
[22]Niall DM, Nutton RW, Keating JF. Palsy of the common peroneal nerve after traumatic dislocation of the knee [J]. J Bone Joint Surg Br, 2005, 87(5):664-667.
[23]Peskun CJ, Chahal J, Steinfeld ZY, et al. Risk factors for peroneal nerve injury and recovery in knee dislocation [J]. Clin Orthop Relat Res, 2012, 47(3):774-778.
[24]Krych AJ, Giuseffi SA, Kuzma SA, et al. Is Peroneal Nerve Injury Associated With Worse Function After Knee Dislocation [J]. Clin Orthop Relat Res, 2014, 47(29):2630-2636.
[25]Edwards GA, Sarasin SM, Davies AP. Dislocation of the knee: an epidemic in waiting [J]? J Emerg Med, 2013, 44(1):68-71.
[26]Peskun CJ, Whelan DB. Outcomes of operative and nonoperative treatment of multiligament knee injuries: an evidence-based review [J]. Sports Med Arthrosc, 2011, 19(2):167-173.
[27] Taylor AR, Arden GP, Rainey HA. Traumatic dislocation of the knee [J]. J Bone Joint Surg Br,1972, 54(5):96-102.
[28] Harner CD, Waltrip RL, Bennett CH. Surgical management of knee dislocations [J]. J Bone Joint Surg Am, 2004, 86(2):262-273.
[29] 段鑫, 杨勇, 肖国庆, 等. 关节镜下修复重建膝关节脱位合并多发韧带损伤的疗效观察 [J]. 中国修复重建外科杂志, 2008, 22(6): 673-675.
[30]Dedmond BT, Almekinders LC. Operative versus nonoperative treatment of knee dislocations: a meta-analysis [J]. Am J Knee Surg, 2001, 14(3):33–38.
[31] Meyers MH, Moore TM, Harvey JP. Traumatic dislocation of the knee joint [J]. J Bone Joint Surg Am, 1975, 57(3):430-433.
[32]刘忠堂, 吴海山. 急性膝关节脱位的手术治疗 [J]. 中华创伤杂志, 2007, 23(4):317-320.
[33]Richter M, Bosch U, Wippermann B, et al. Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations [J]. Am J Sports Med, 2002, 30(5):718-727.
[34]Hughston JC, Andrews JR, Cross MJ, et al. Classification of knee ligament instabilities [J], The Journal of Bone and Joint Surgery,1976, 58(2):173-179.
[35]陈志伟, 刘春磊, 杨乐忠, 等. 分期治疗外伤性膝关节脱位合并多韧带损伤的疗效观察 [J]. 中国修复重建外科杂志, 2011, 25(2):225-228.
[36] Kohl S. Stock A. Ahmad SS. Zumstein M. Dynamic intraligamentary stabilization and primary repair: A new concept for the treatment of knee dislocation [J]. Injury, 2015, 46(4):724-728.

The early diagnosis of knee dislocation and its minimally invasive treatment methods

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