Collins D N, Temple S D
Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock 72205.
Clin Orthop Relat Res. 1989 Jun(243):48-56.
Experience with wounds involving the major joints of the lower extremity suggests that the extracapsular soft tissues and the intracapsular structures should be considered individually to assess accurately the magnitude of injury and to provide a prognosis. A classification scheme is proposed to characterize the areas and types of injury. Type I open joint injuries are single penetrations without extensive soft-tissue damage, permitting uncomplicated joint and wound closure. Type II injuries are single or multiple penetrations with extensive soft-tissue disruptions (flaps, avulsions, degloving), often requiring secondary operations to attain closure. Type III injuries are open periarticular fractures with extension through the adjacent intraarticular surface. Type IV injuries are open dislocations or those with associated nerve or vascular injury requiring repair. The extent of intraarticular injury further subdivides Types I, II, and III. The prognosis for functional impairment correlates with the severity of injury. The cornerstones for successful management are debridement, antibiotic therapy, properly timed and performed joint closure, and aggressive treatment of the associated bony injury.
涉及下肢主要关节的伤口处理经验表明，应分别考虑关节囊外软组织和关节囊内结构，以准确评估损伤程度并做出预后判断。现提出一种分类方案来描述损伤的部位和类型。I型开放性关节损伤为单一穿透伤，无广泛软组织损伤，可进行简单的关节和伤口闭合。II型损伤为单一或多发穿透伤，伴有广泛软组织破坏（皮瓣、撕脱伤、脱套伤），常需二期手术才能闭合伤口。III型损伤为开放性关节周围骨折，骨折延伸至相邻关节内表面。IV型损伤为开放性脱位或伴有需要修复的神经或血管损伤。关节内损伤的程度进一步细分I、II和III型。功能障碍的预后与损伤严重程度相关。成功治疗的基石是清创、抗生素治疗、适时且恰当的关节闭合以及积极治疗相关的骨损伤。
