R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland, Baltimore, MD, USA.
J Orthop Trauma. 2013 Apr;27(4):226-31. doi: 10.1097/BOT.0b013e318270def4.
To characterize multiligamentous knee injury patterns and describe associated morbidities.
Retrospective.
Level I trauma center.
One hundred two patients (106 knees) with multiligamentous knee injuries and/or dislocations from 2000 through 2008. Subgroup of 82 knees with appropriate magnetic resonance images available assessed for ligamentous injury patterns.
Data obtained from medical records for 106 knees.
Presence of arterial injuries, nerve injuries, associated fracture patterns, and whole-body morbidities.
The most common (43%) injury pattern was a combined disruption of the anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner. Twenty-five percent of knees had associated ipsilateral tibial plateau fractures, and 19% had associated ipsilateral femoral fractures. Peroneal nerve injury occurred in 25% of knees, arterial injury in 21%, and compartment syndrome in 16%. An intra-abdominal injury was present in 13% of patients, a severe closed head injury in 10%, and a symptomatic pulmonary embolism in 5%.
Nearly half the multiligamentous knee injuries involved the anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner; one-fourth had associated ipsilateral tibial plateau fractures. The incidence of peroneal nerve injury (25%) was higher than previously reported (20%), whereas the incidence of arterial injury (21%) was comparable to previous reports (19%). Posterolateral corner injuries were more prevalent than previously reported and were highly associated with peroneal nerve injury. We found a substantial incidence of associated morbidities of the whole body. Multiligamentous knee injuries are a marker of concomitant trauma and should be closely evaluated at presentation and during the hospital course to allow for early intervention for life- or limb-threatening comorbidities.
描述多韧带膝关节损伤的模式，并描述相关的并发症。
回顾性研究。
一级创伤中心。
2000 年至 2008 年期间，102 例（106 膝）多韧带膝关节损伤和/或脱位患者。亚组 82 例膝关节有适当的磁共振成像可供评估韧带损伤模式。
106 例膝关节的资料来源于病历。
动脉损伤、神经损伤、伴发骨折模式和全身合并症的存在情况。
最常见（43%）的损伤模式是前交叉韧带、后交叉韧带和后外侧角的联合撕裂。25%的膝关节有同侧胫骨平台骨折，19%有同侧股骨骨折。腓总神经损伤发生在 25%的膝关节，动脉损伤发生在 21%，筋膜间室综合征发生在 16%。13%的患者存在腹部损伤，10%有严重的闭合性颅脑损伤，5%有症状性肺栓塞。
近一半的多韧带膝关节损伤涉及前交叉韧带、后交叉韧带和后外侧角；四分之一有同侧胫骨平台骨折。腓总神经损伤（25%）的发生率高于既往报道（20%），而动脉损伤（21%）的发生率与既往报道（19%）相当。后外侧角损伤比既往报道更为常见，且与腓总神经损伤高度相关。我们发现全身合并症的发生率相当高。多韧带膝关节损伤是合并创伤的标志，在就诊时和住院期间应进行密切评估，以便对危及生命或肢体的合并症进行早期干预。
