Fanelli Gregory C, Stannard James P, Stuart Michael J, Macdonald Peter B, Marx Robert G, Whelan Daniel B, Boyd Joel L, Levy Bruce A
Department of Orthopaedic Surgery, Geisinger Orthopaedics, Danville, PA, USA.
Instr Course Lect. 2011;60:523-35.
The ideal management of the dislocated knee remains controversial. These injuries often can be elusive; a significant number of dislocated knees spontaneously reduce and appear relatively benign on routine radiographs. A high index of suspicion, based on the mechanism of injury, soft-tissue assessment of the limb, and the level of knee instability should alert the physician to the possibility of a dislocated knee. Early recognition and appropriate neurovascular assessment is paramount to the successful treatment of these complex injuries. Controversies exist regarding surgical versus nonsurgical management, early versus delayed surgery, the use of allograft versus autograft tissue, the decision to repair versus reconstruct torn ligamentous structures, and the type of reconstruction technique and postoperative rehabilitation program. To achieve optimal patient care, it is important to be aware of the current evaluation and treatment strategies for complex knee ligament injuries, including modern anatomic reconstruction techniques. Current recommendations include measurement of the ankle-brachial indices in each patient, early surgical management, the use of autograft or allograft tissue, reconstruction as opposed to repair alone of the fibular collateral ligament/posterolateral corner structures, reconstruction of the anterior and posterior cruciate ligaments, and repair and/or reconstruction of the medial collateral ligament/posteromedial corner depending on the injury pattern and the quality of tissue.
膝关节脱位的理想治疗方法仍存在争议。这些损伤往往难以捉摸；相当数量的膝关节脱位会自行复位，在常规X线片上看起来相对正常。基于损伤机制、肢体软组织评估和膝关节不稳定程度的高度怀疑指数应提醒医生注意膝关节脱位的可能性。早期识别和适当的神经血管评估对于成功治疗这些复杂损伤至关重要。关于手术治疗与非手术治疗、早期手术与延迟手术、同种异体移植物与自体移植物组织的使用、修复与重建撕裂的韧带结构的决定以及重建技术类型和术后康复计划存在争议。为了实现最佳的患者护理，了解复杂膝关节韧带损伤的当前评估和治疗策略，包括现代解剖重建技术非常重要。当前的建议包括测量每位患者的踝肱指数、早期手术治疗、使用自体移植物或同种异体移植物组织、重建而非仅修复腓侧副韧带/后外侧角结构、重建前后交叉韧带，以及根据损伤模式和组织质量修复和/或重建内侧副韧带/后内侧角。
