Unité de traumatologie-orthopédie de Purpan, institut de l'appareil locomoteur, CHU de Toulouse, Blace Baylac, Toulouse 31052 cedex, France.
Orthop Traumatol Surg Res. 2010 Feb;96(1):64-9. doi: 10.1016/j.rcot.2009.12.004.
The occurrence rate of common peroneal nerve (CPN) palsy associated with knee dislocation or bicruciate ligament injury ranges from 10 to 40%. The present study sought first to describe the anatomic lesions encountered and their associated prognoses and second to recommend adequate treatment strategy based on a prospective multicenter observational series of knee ligament trauma cases.
Twelve out of 67 knees treated for dislocation or bicruciate lesion presented associated CPN palsy: two females, 10 males; mean age, 32 years. Four sports injuries,three traffic accidents and five other etiologies led to seven complete dislocations and five bicruciate ruptures. Four cases involved associated popliteal artery laceration ischemia; one of the dislocations was open. Paralysis was total in eight cases and partial in four. There were two complete ruptures, three contusions with CPN in continuity stretch lesions and three macroscopically normal aspects.
At a minimum 1 year's follow-up, regardless of the initial surgical technique performed,recovery was complete in six cases, partial (in terms of motor function) in one and absent in five. Without specific CPN surgery, spontaneous recovery was partial in one case, complete in two and absent in none. Following simple emergency or secondary neurolysis, remission was total in four cases and absent in one. Three nerve grafts were all associated with non-recovery.
The present results agree with literature findings. Palsy rates varied with trauma circumstances and departmental recruitment. Neurologic impairment was commensurate to ligamentary damages. The anatomic status of the CPN, subjected to violent traction by dislocation,was the most significant prognostic factor for neurologic recovery. In about 25% of dislocations, contusion-elongation over several centimeters was associated with as poor a prognosis as total rupture. CPN neurolysis is recommended when early clinical and EMG recovery fails to progress and/or in case of lateral ligamentary reconstruction. Possible peripheral nerve impairment needs to be included in the overall functional assessment of treatment for severe ligaments injuries and knee dislocation.
Level IV, prospective study.
膝关节脱位或前后十字韧带损伤合并常见腓总神经（CPN）麻痹的发生率为 10%至 40%。本研究首先描述了遇到的解剖损伤及其相关预后，其次根据膝关节韧带创伤病例的前瞻性多中心观察系列，建议采用适当的治疗策略。
在 67 例因脱位或前后十字韧带损伤而接受治疗的膝关节中，有 12 例合并 CPN 麻痹：2 例女性，10 例男性；平均年龄 32 岁。4 例运动损伤，3 例交通事故，5 例其他病因导致 7 例完全脱位和 5 例前后十字韧带断裂。4 例合并腘动脉撕裂缺血；1 例为开放性脱位。8 例完全麻痹，4 例部分麻痹。有 2 例完全断裂，3 例连续性伸展损伤的挫伤，3 例大体正常。
至少随访 1 年，无论最初采用何种手术技术，6 例完全恢复，1 例部分恢复（运动功能），5 例无恢复。未行特定 CPN 手术，1 例自发部分恢复，2 例完全恢复，无 1 例无恢复。单纯急诊或二期神经松解后，4 例完全缓解，1 例无缓解。3 例神经移植均无恢复。
本研究结果与文献报道一致。麻痹发生率与创伤情况和科室招募有关。神经损伤与韧带损伤程度一致。CPN 的解剖状态，在脱位时受到剧烈的牵引，是神经恢复的最重要预后因素。在大约 25%的脱位中，几厘米长的挫伤-延长与完全断裂一样预后不良。当早期临床和 EMG 恢复没有进展时，或者在外侧韧带重建时，建议进行 CPN 神经松解。在严重的韧带损伤和膝关节脱位的整体功能评估中，需要考虑可能存在的周围神经损伤。
IV 级，前瞻性研究。
