Teissier Victoria, Tresson Philippe, Gaudric Julien, Davaine Jean-Michel, Scemama Caroline, Raux Mathieu, Chiche Laurent, Koskas Fabien
Department of Vascular Surgery, Groupe Hospitalier Pitié-Salpétrière Charles Foix, APHP, Université Paris6, Paris, France.
Department of Vascular Surgery, Groupe Hospitalier Pitié-Salpétrière Charles Foix, APHP, Université Paris6, Paris, France.
Ann Vasc Surg. 2019 Nov;61:238-245. doi: 10.1016/j.avsg.2019.04.016. Epub 2019 Jul 22.
Arterial injury secondary to acute knee dislocation (KD) is a rare but devastative complication. The aim of this study is to evaluate functional sequelae and factors of poor prognosis.
A retrospective monocentric series of consecutive KD with acute ischemia by popliteal artery injury was analyzed between 2005 and 2017. The main outcome was the amputation rate.
Sixteen dislocations were included. Nine (56%) were due to public road accidents, 5 (31%) were due to falls from height, and 2 (13%) were due to sports injuries. Dislocation had occurred in the posterior location in 8 (50%) cases. Regarding arterial injury, there were 7 (44%) ruptures, 7 (44%) dissections, and 2 (13%) isolated thromboses. Eleven (69%) KDs with vascular trauma were associated with signs of acute ischemia. Revascularization was achieved by anatomical venous bypass in 14 (88%), resection and direct anastomosis in one (6%), and isolated thrombectomy in one (6%). Median time to surgery (time between trauma and vascular repair) was 7 hours (3.25-60.92 hours). Primary revascularization was performed in 12 (75%) cases. In three cases (19%), orthopedic reduction and stabilization were performed first. In one case, (6%) three-step management with vascular shunt at first, then with knee stabilization, and finally vascular bypass was carried out. Stabilization was achieved by using an external fixator in 13 (82%) cases, by open reduction and internal fixation in one case (6%), by ligamentoplasty in one (6%), and by using a long leg cast in one (6%). Fasciotomy was required in 12 (75%) cases. Two patients had early vascular complications, and 2 had early systemic complications. Three secondary transfemoral amputations were performed. Median follow-up duration was 23 months. No secondary amputation was recorded. At the end of follow-up, functional outcomes were evaluated using the Oxford Knee Score (OKS). The median OKS was 30 versus the pretrauma median OKS of 47 (P < 0.00028). No risk factor associated with limb amputation has been highlighted.
Analysis of these results provided indications for therapeutic management of this condition. This study shows poor functional outcomes because of severity of vascular lesion in patients with orthopedic trauma but with healthy arteries.
急性膝关节脱位（KD）继发的动脉损伤是一种罕见但具有毁灭性的并发症。本研究的目的是评估功能后遗症和预后不良的因素。
对2005年至2017年间因腘动脉损伤导致急性缺血的连续性KD进行回顾性单中心系列分析。主要结局是截肢率。
纳入16例脱位病例。9例（56%）因公共道路交通事故导致，5例（31%）因高处坠落导致，2例（13%）因运动损伤导致。8例（50%）脱位发生在膝关节后方。关于动脉损伤，有7例（44%）破裂，7例（44%）夹层，2例（13%）孤立性血栓形成。11例（69%）伴有血管创伤的KD与急性缺血体征相关。14例（88%）通过解剖学静脉旁路实现血运重建，1例（6%）通过切除和直接吻合实现血运重建，1例（6%）通过孤立性血栓切除术实现血运重建。手术中位时间（创伤至血管修复的时间）为7小时（3.25 - 60.92小时）。12例（75%）进行了一期血运重建。3例（19%）首先进行了骨科复位和固定。1例（6%）采用了三步处理，首先进行血管分流，然后进行膝关节固定，最后进行血管旁路手术。13例（82%）通过使用外固定器实现固定，1例（6%）通过切开复位内固定实现固定，1例（6%）通过韧带成形术实现固定，1例（6%）通过使用长腿石膏实现固定。12例（75%）需要进行筋膜切开术。2例患者出现早期血管并发症，2例出现早期全身并发症。进行了3例二期经股截肢手术。中位随访时间为23个月。未记录到二期截肢。随访结束时，使用牛津膝关节评分（OKS）评估功能结局。OKS中位数为30，而创伤前OKS中位数为47（P < 0.00028）。未发现与肢体截肢相关的危险因素。
对这些结果的分析为该疾病的治疗管理提供了依据。本研究表明，对于骨科创伤但动脉健康的患者，由于血管病变严重导致功能结局较差。
