Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, C/Sant Quintí 89, 08041, Barcelona, Catalunya, Spain.
ICATME, Hospital Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain.
Arch Orthop Trauma Surg. 2022 Feb;142(2):255-261. doi: 10.1007/s00402-020-03684-0. Epub 2020 Nov 22.
Vascular injuries after traumatic knee dislocation pose a potential limb threat for the patient. The benefits of external fixation have been described by many authors. However, the usefulness of the external fixator during acute management of knee dislocations with vascular injuries is a controversial aspect that has no consensus in the literature. The purpose of the present study was to provide data from the current literature on the utility of the external fixator and to investigate the percentage of knee dislocations with vascular injuries treated with an external fixator, the timing between external fixator and vascular repair, and the total time of external fixator.
The present systematic review was conducted according to the PRISMA checklist. MEDLINE (Pubmed), Web of Science, and SCOPUS databases were searched for articles from 1 January 2000 to 6 February 2019. Studies reporting outcomes of treatment of knee dislocations with vascular injuries were included. Exclusion criteria included studies investigating chronic knee dislocations, knee arthroplasties, editorials, case reports, and expert opinions. Two authors independently extracted data and appraised the quality of evidence and risk of bias using the Methodological quality and synthesis of case series and case reports.
Descriptive statistics were used to report the outcome of our findings. Seven studies related to the usefulness of the external fixator during acute management of knee dislocations with vascular injuries were included. The external fixator had been used in the majority of knee dislocations with vascular lesions (72%). Timing between external fixator and vascular repair was reported on four studies (57%), two studies performed external fixation before vascular repair, and two studies performed external fixation after vascular repair. Total time of external fixator was only reported on three studies, ranging from 3 weeks to 3 months. These studies reported acute management, without referring to long-term results and without comparative groups.
External fixator was used in the majority of knee dislocations with vascular injuries but the justification for its use remained unclear. Larger studies are needed to fully understand the merit of the external fixator in knee dislocations with vascular injuries. Joint protocols between vascular surgeons and trauma surgeons are necessary to agree on the aspects related to the management of knee dislocations with vascular injuries.
IV.
创伤性膝关节脱位后发生的血管损伤对患者的肢体构成潜在威胁。许多作者都描述了外固定架的益处。然而，在伴有血管损伤的膝关节脱位的急性处理中外固定架的有用性是一个有争议的方面，在文献中没有共识。本研究的目的是提供当前文献中关于外固定架的使用数据，并调查接受外固定架治疗的伴有血管损伤的膝关节脱位的比例、外固定架与血管修复之间的时间以及外固定架的总时间。
本系统评价根据 PRISMA 清单进行。从 2000 年 1 月 1 日至 2019 年 2 月 6 日，检索 MEDLINE（Pubmed）、Web of Science 和 SCOPUS 数据库中有关治疗伴有血管损伤的膝关节脱位的文章。纳入报告治疗伴有血管损伤的膝关节脱位结果的研究。排除标准包括研究慢性膝关节脱位、膝关节置换术、社论、病例报告和专家意见。两名作者独立提取数据，并使用方法学质量和病例系列和病例报告的综合评估证据质量和偏倚风险。
使用描述性统计报告我们发现的结果。纳入了 7 项关于在伴有血管损伤的膝关节脱位的急性处理中外固定架的有用性的研究。外固定架已被用于大多数伴有血管病变的膝关节脱位（72%）。有四项研究报告了外固定架与血管修复之间的时间（57%），两项研究在血管修复前进行了外固定，两项研究在血管修复后进行了外固定。只有三项研究报告了外固定架的总时间，范围从 3 周到 3 个月。这些研究报告了急性处理，没有提到长期结果，也没有比较组。
外固定架在大多数伴有血管损伤的膝关节脱位中使用，但使用的理由仍不清楚。需要更大的研究来充分了解外固定架在伴有血管损伤的膝关节脱位中的作用。血管外科医生和创伤外科医生之间需要制定联合方案，以就伴有血管损伤的膝关节脱位的管理方面达成一致。
IV。
