Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
J Am Acad Orthop Surg. 2013 Jun;21(6):343-54. doi: 10.5435/JAAOS-21-06-343.
Multiligament knee injuries account for <0.02% of all orthopaedic injuries, and 16% to 40% of these patients suffer associated injury to the common peroneal nerve (CPN). The proximity of the CPN to the proximal fibula predisposes the nerve to injury during local trauma and dislocation; the nerve is highly vulnerable to stretch injury during varus stress, particularly in posterolateral corner injuries. CPN injuries have a poor prognosis compared with that of other peripheral nerve injuries. Management is determined based on the severity and location of nerve injury, timing of presentation, associated injuries requiring surgical management, and the results of serial clinical evaluations and electrodiagnostic studies. Nonsurgical treatment options include orthosis wear and physical therapy. Surgical management includes one or more of the following: neurolysis, primary nerve repair, intercalary nerve grafting, tendon transfer, and nerve transfer. Limited evidence supports the use of early one-stage nerve reconstruction combined with tendon transfer; however, optimal management of these rare injuries continues to change, and treatment should be individualized.
多韧带膝关节损伤占所有骨科损伤的<0.02%，其中 16%至 40%的患者并发腓总神经（CPN）损伤。CPN 靠近腓骨近端，易在局部创伤和脱位时受伤；在外翻应力下，CPN 极易受到伸展损伤，尤其是在后外侧角损伤时。与其他周围神经损伤相比，CPN 损伤的预后较差。治疗方案取决于神经损伤的严重程度和位置、就诊时机、需要手术治疗的相关损伤以及连续临床评估和电诊断研究的结果。非手术治疗选择包括矫形器佩戴和物理治疗。手术治疗包括以下一种或多种方法：神经松解术、神经修复术、神经间置移植术、肌腱转移术和神经转移术。有限的证据支持早期一期神经重建联合肌腱转移术的应用；然而，这些罕见损伤的最佳治疗方法仍在不断变化，治疗应个体化。
