Krych Aaron J, Giuseffi Steven A, Kuzma Scott A, Stuart Michael J, Levy Bruce A
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA,
Clin Orthop Relat Res. 2014 Sep;472(9):2630-6. doi: 10.1007/s11999-014-3542-9.
Peroneal nerve palsy is a frequent and potentially disabling complication of multiligament knee dislocation, but little information exists on the degree to which patients recover motor or sensory function after this injury, and whether having this nerve injury--with or without complete recovery--is a predictor of inferior patient-reported outcome scores.
QUESTIONS/PURPOSES: The purposes of this study were to (1) report on motor and sensory recovery as well as patient-reported outcomes scores of patients with peroneal nerve injury from multiligament knee dislocation; (2) compare those endpoints between patients who had partial versus complete nerve injuries; and (3) compare patient-reported outcomes among patients who sustained peroneal nerve injuries after knee dislocation with a matched cohort of multiligament knee injuries without nerve injury.
Thirty-two patients were identified, but five did not have 2-year followup and are excluded (16% lost to followup). Twenty-seven patients (24 male, three female) with peroneal nerve injury underwent multiligament knee reconstruction and were followed for 6.3 years (range, 2-18 years). Motor grades were assessed by examination and outcomes by International Knee Documentation Committee (IKDC) and Lysholm scores. Retrospectively, patients were divided into complete (n = 9) and partial nerve palsy (n = 18). Treatment for complete nerve palsy included an ankle-foot orthosis for all patients, nonoperative (one), neurolysis (two), tendon transfer (three), nerve transfer (one), and combined nerve/tendon transfer (one). Treatment for partial nerve palsy included nonoperative (12), neurolysis (four), nerve transfer (one), and combined nerve/tendon transfer (one). Furthermore, patients without nerve injury were matched by Schenck classification, age, and sex. Data were analyzed using univariate and multivariate models.
Overall, 18 patients (69%) regained antigravity ankle dorsiflexion after treatment (three complete nerve palsy [38%] versus 15 partial nerve palsy [83%]; p = 0.06). One patient with complete nerve palsy (13%) and 13 patients with partial nerve palsy (72%) regained antigravity extensor hallucis longus strength (p = 0.01). IKDC and Lysholm scores were similar between complete nerve palsy and partial nerve palsy groups. After controlling for confounding variables such as patient age, body mass index, injury interval to surgery, mechanism of injury, bicruciate injury, and popliteal artery injury status, there was no difference between patients with peroneal nerve injury and those without on Lysholm or IKDC scores.
With multiligament knee dislocation and associated peroneal nerve injury, patients with partial nerve injury are more likely to regain antigravity strength when compared with those with a complete nerve injury, but their overall function may not improve. After controlling for confounding variables in a multivariate model, there was no difference in Lysholm or IKDC scores between patients with peroneal nerve injury and those without.
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
腓总神经麻痹是多韧带膝关节脱位常见且可能导致残疾的并发症，但关于患者在此类损伤后运动或感觉功能恢复的程度，以及无论神经损伤是否完全恢复，该神经损伤是否为患者报告结局评分较低的预测因素，目前所知甚少。
问题/目的：本研究的目的是：（1）报告多韧带膝关节脱位所致腓总神经损伤患者的运动和感觉恢复情况以及患者报告的结局评分；（2）比较部分神经损伤与完全神经损伤患者的上述终点指标；（3）比较膝关节脱位后发生腓总神经损伤的患者与匹配的无神经损伤的多韧带膝关节损伤队列患者的患者报告结局。
共确定了32例患者，但5例未进行2年随访而被排除（16%失访）。27例（24例男性，3例女性）腓总神经损伤患者接受了多韧带膝关节重建，并随访了6.3年（范围2 - 18年）。通过检查评估运动分级，采用国际膝关节文献委员会（IKDC）和Lysholm评分评估结局。回顾性地将患者分为完全性（n = 9）和部分性神经麻痹（n = 18）。完全性神经麻痹的治疗包括所有患者均使用踝足矫形器、非手术治疗（1例）、神经松解术（2例）、肌腱转移术（3例）、神经转移术（1例）以及联合神经/肌腱转移术（1例）。部分性神经麻痹的治疗包括非手术治疗（12例）、神经松解术（4例）、神经转移术（1例）以及联合神经/肌腱转移术（1例）。此外，根据Schenck分类、年龄和性别对无神经损伤的患者进行匹配。采用单变量和多变量模型分析数据。
总体而言，18例患者（69%）治疗后恢复了踝关节抗重力背屈（3例完全性神经麻痹患者[38%]对比15例部分性神经麻痹患者[83%]；p = 0.06）。1例完全性神经麻痹患者（13%）和13例部分性神经麻痹患者（72%）恢复了拇长伸肌抗重力力量（p = 0.01）。完全性神经麻痹组和部分性神经麻痹组的IKDC和Lysholm评分相似。在控制了诸如患者年龄、体重指数、受伤至手术间隔时间、损伤机制、双十字韧带损伤和腘动脉损伤状态等混杂变量后，腓总神经损伤患者与无神经损伤患者在Lysholm或IKDC评分上无差异。
对于多韧带膝关节脱位及相关腓总神经损伤，部分性神经损伤患者比完全性神经损伤患者更有可能恢复抗重力力量，但他们的整体功能可能并未改善。在多变量模型中控制混杂变量后，腓总神经损伤患者与无神经损伤患者在Lysholm或IKDC评分上无差异。
III级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
