Hollis Jeffrey D, Daley Brian J
Department of Surgery, Division of Trauma and Critical Care, University of Tennessee Medical Center at Knoxville, Knoxville, Tennessee 37920, USA.
J Trauma. 2005 Sep;59(3):672-5; discussion 675-6.
Historically, arteriography has been used routinely in patients with knee dislocations. Recently, selectivity based on physical examination (PE) has emerged. Critics cite limited clinical evidence. We sought to determine whether PE accurately confirms or excludes surgically significant vascular injuries associated with knee dislocations.
We conducted an institutional review board-approved retrospective review of patients admitted at a university-based Level I trauma center with knee dislocations from January 1, 1993, to December 31, 2002. Thirty-nine patients (28 male patients and 11 female patients; average age, 42.8 years) had 39 dislocations (27 left and 12 right, 26 posterior and 13 anterior). Most patients (n = 25) were involved in motor vehicle crashes. All patients underwent arteriography.
Of the 20 normal arteriograms, all had normal PE. Of the 19 abnormal arteriograms, 8 had a normal PE and 11 were abnormal. Within this subgroup, none of the 8 with normal PE required surgery, whereas 7 of the 11 with abnormal PE required surgery. None of the nonoperative patients had vascular complications during the hospital stay. Sensitivity and specificity were 100% for PE on surgically significant vascular injury.
Routine arteriography is unnecessary in patients with a normal PE after reduction of the knee dislocation.
过去，动脉造影术常用于膝关节脱位患者。近来，基于体格检查（PE）的选择性检查方法出现了。批评者认为临床证据有限。我们试图确定体格检查能否准确证实或排除与膝关节脱位相关的具有手术意义的血管损伤。
我们对1993年1月1日至2002年12月31日在一所大学一级创伤中心收治的膝关节脱位患者进行了一项经机构审查委员会批准的回顾性研究。39例患者（28例男性患者和11例女性患者；平均年龄42.8岁）发生了39次脱位（27例左侧和12例右侧，26例后脱位和13例前脱位）。大多数患者（n = 25）因机动车碰撞受伤。所有患者均接受了动脉造影。
在20例动脉造影正常的患者中，体格检查均正常。在19例动脉造影异常的患者中，8例体格检查正常，11例异常。在这个亚组中，8例体格检查正常的患者均无需手术，而11例体格检查异常的患者中有7例需要手术。非手术患者在住院期间均无血管并发症。体格检查对具有手术意义的血管损伤的敏感性和特异性均为100%。
膝关节脱位复位后体格检查正常的患者无需常规进行动脉造影。
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