Department of Orthopaedic Surgery, Hospital Clínico Mutual de Seguridad, Avenida Libertador Bernardo O'Higgins 4848, Santiago, Chile.
Department of Musculoskeletal Radiology, Hospital Clínico Mutual de Seguridad, Santiago, Chile.
Int Orthop. 2020 Jun;44(6):1195-1200. doi: 10.1007/s00264-020-04517-w. Epub 2020 Mar 7.
This study aims to identify multiple ligament knee injury patterns that possess a high-risk of vascular lesion.
We retrospectively compared torn ligament patterns and the presence of vascular lesions confirmed by magnetic resonance imaging and computed tomography angiography from 122 consecutive patients with diagnoses of multiple ligament knee injury made at the emergency department between January 2012 and December 2017. Patients were not eligible if they had an ipsilateral lower extremity lesion (dislocations or fractures at another level), initial evaluation at another hospital, or follow-up for less than 12 months. The primary outcomes were the comparison between the imaging findings of torn structures patterns and the presence of a vascular lesion.
We identified 48 eligible patients (50 knees) with multiligamentary knee lesions, of whom eight had popliteal artery damage, yielding an incidence of 16%. Our clinical examination detected six of these patients that were classified, according to the Schenck system, as KD-IIIL (6 knees) and KD-IIIM (2 knees). The odds of having a popliteal artery injury is 4.69 to 1 with a KD-IIIL injury that with any other type of injury on that classification (95% CI 0.960-22.98).
This data suggests that varus forces causing enough energy to produce a KD-IIIL lesion possess a higher popliteal artery injury risk, making recommendable a thorough examination of the vascular integrity when diagnosing a KD-IIIL lesion.
本研究旨在确定多种韧带膝关节损伤模式，这些损伤模式存在高血管损伤风险。
我们回顾性比较了撕裂的韧带模式以及通过磁共振成像和计算机断层血管造影术在 2012 年 1 月至 2017 年 12 月期间在急诊部诊断为多韧带膝关节损伤的 122 例连续患者中证实的血管损伤。如果患者存在同侧下肢损伤（脱位或骨折在另一部位）、在另一家医院进行初始评估或随访时间少于 12 个月，则不符合入选条件。主要结局是撕裂结构模式的影像学发现与血管损伤之间的比较。
我们确定了 48 例符合条件的多韧带膝关节病变患者（50 膝），其中 8 例存在腘动脉损伤，发生率为 16%。我们的临床检查发现了其中 6 例患者，根据 Schenck 系统分类为 KD-IIIL（6 膝）和 KD-IIIM（2 膝）。KD-IIIL 损伤的腘动脉损伤几率是其他任何损伤类型的 4.69 倍（95%CI 0.960-22.98）。
这些数据表明，导致足够能量产生 KD-IIIL 病变的内翻力具有更高的腘动脉损伤风险，因此在诊断 KD-IIIL 病变时建议对血管完整性进行彻底检查。
