Andrade-Silva Fernando Brandao, Carvalho Adriana, Mansano Caio, Giese Aline, de Camargo Leonhardt Marcos, Barbosa Dennis, Kojima Kodi Edson, Silva Jorge Santos
Department of Orthopedics and Traumatology, University of Sao Paulo, Brazil.
Department of Orthopedics and Traumatology, University of Sao Paulo, Brazil.
Injury. 2017 Oct;48 Suppl 4:S2-S5. doi: 10.1016/S0020-1383(17)30767-2.
According to Fraser's description, ipsilateral femoral and tibial diaphyseal fractures are characterised as type I floating knee and have a better prognosis than fractures with joint involvement (type II). There are few reports of functional and muscle strength in these patients. The objective of this study was to evaluate the functional and isokinetic muscle strength of patients with type I floating knee undergoing femoral and tibial internal fixation.
Patients with type I floating knee undergoing concomitant femoral and tibial internal fixation were invited for clinical evaluation. The parameters evaluated included the following: Karlstrom and Olerud score; Lysholm score; isokinetic thigh and hip muscle evaluation; knee range of motion; pain level; investigation of associated knee injuries by clinical evaluation and MRI; and types of complications.
Twenty-one patients were included in the study; 11 of these were clinically evaluated, with a mean follow-up of 23.9 months. Six patients had an acceptable result according to the Karlstrom criteria, whereas eight patients had a poor result based on the Lysholm scale. The peak torque deficit was 61% for knee extensors, 37% for flexors and -9% for hip abductors. The mean pain level was 5.9. Three patients had a partial anterior cruciate ligament (ACL) injury; one patient had a posterior cruciate ligament (PCL) injury; and three patients had a meniscal injury. There were four cases of tibial or femoral nonunion at one year and two cases of chronic osteomyelitis.
Patients with type I floating knee had unsatisfactory functional results, significant knee extensor and flexor muscle strength deficits and a significant rate of complications at the two-year follow-up.
根据弗雷泽的描述，同侧股骨干和胫骨干骨折被归类为I型浮动膝，其预后比累及关节的骨折（II型）更好。关于这些患者的功能和肌肉力量的报道较少。本研究的目的是评估接受股骨和胫骨内固定的I型浮动膝患者的功能和等速肌肉力量。
邀请接受股骨和胫骨内固定的I型浮动膝患者进行临床评估。评估的参数包括：卡尔斯特伦和奥勒鲁德评分；莱肖尔姆评分；大腿和髋部等速肌肉评估；膝关节活动范围；疼痛程度；通过临床评估和MRI调查相关膝关节损伤；以及并发症类型。
21名患者纳入研究；其中11名接受了临床评估，平均随访23.9个月。根据卡尔斯特伦标准，6名患者结果可接受，而根据莱肖尔姆量表，8名患者结果较差。膝关节伸肌的峰值扭矩 deficit为61%，屈肌为37%，髋外展肌为-9%。平均疼痛程度为5.9。3名患者有部分前交叉韧带（ACL）损伤；1名患者有后交叉韧带（PCL）损伤；3名患者有半月板损伤。1年时有4例胫骨或股骨骨不连，2例慢性骨髓炎。
I型浮动膝患者在两年随访时功能结果不理想，膝关节伸肌和屈肌力量明显 deficit，并发症发生率较高。
