后髋臼骨折伴发膝关节损伤：值得关注的关联。

Knee injuries concomitant to posterior acetabular fractures: an association to look for.

机构信息

Orthopedic Surgery Department, Groupe Hospitalier Paris Saint-Joseph, Paris, France.

Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.

出版信息

Int Orthop. 2021 Jan;45(1):247-251. doi: 10.1007/s00264-020-04885-3. Epub 2020 Nov 26.

DOI:10.1007/s00264-020-04885-3

PMID:33244635

Abstract

PURPOSE

Acetabular fractures are frequently associated with other skeletal injuries, particularly knee injuries. This study aims to evaluate the relationship between posterior acetabular fractures and knee injury, analyzing its patterns and association with other injuries.

METHODS

This is a retrospective monocentric study in a tertiary referral centre. We reviewed the data (age, sex, type of fracture, and concomitant injury) of patients hospitalized for a posterior acetabular fracture. We recorded concomitant knee injury diagnosed up to one year following acetabular fracture.

RESULTS

Two-hundred-seventeen patients (177 males/40 females) were included. The mean age was 40.5 years. Eighty-five patients (39%) had a concomitant hip dislocation, nine (4.1%) had sciatic nerve palsy, 17 (7.8%) had upper extremity injury, and 18 (8.3%) had lower extremity injury (other than the knee). Eight (3.7%) patients had spine injury, 11 (5.1%) had severe thoracic injury, nine (4.1%) had an abdominal injury, and four (1.8%) had a head injury. There were 33 (15.21%, 95% CI 10.80-20.8%) patients (30 M/3 F) (group 1) with a concomitant knee injury and 184 patients without a concomitant knee injury(group 2). The mean age in group 1 was 34.3 compared to 45.4 in group 2(p = 0.021). The pattern analysis revealed five fractures, 14 ligamentous injuries (PCL injuries = 68%), and 14 soft tissue injuries. Sixteen (48.48%) injuries were identified during hospitalization and 17 (51.51%) during follow-up. There were an association between knee injury and upper extremity injury (OR = 3.49 95% CI 1.12-10.00,p = 0.022) and other lower extremity injury (OR = 3.18 95% CI 1.03-8.95,p = 0.032).

DISCUSSION

Knee injury is the second most frequent lesion associated with posterior acetabular fractures. Being missed in half of cases, we recommend a systematic examination of ipsilateral knees under general anaesthesia, keeping a high index of suspicion and a low threshold for complementary knee imaging. Knee injury should be mainly looked for in patients younger than 60 years and in those with upper and/or lower extremities injuries.

摘要

目的

髋臼骨折常伴有其他骨骼损伤，尤其是膝关节损伤。本研究旨在评估后髋臼骨折与膝关节损伤之间的关系，分析其类型和与其他损伤的关联。

方法

这是一项在三级转诊中心进行的回顾性单中心研究。我们回顾了因后髋臼骨折住院患者的（年龄、性别、骨折类型和伴随损伤）数据。我们记录了髋臼骨折后 1 年内诊断出的伴随膝关节损伤。

结果

共纳入 217 例患者（177 例男性/40 例女性），平均年龄为 40.5 岁。85 例（39%）患者伴有髋关节脱位，9 例（4.1%）伴有坐骨神经损伤，17 例（7.8%）上肢损伤，18 例（8.3%）下肢损伤（不包括膝关节）。8 例（3.7%）患者有脊柱损伤，11 例（5.1%）有严重胸部损伤，9 例（4.1%）有腹部损伤，4 例（1.8%）有头部损伤。33 例（15.21%，95%CI 10.80-20.8%）患者（30 例男性/3 例女性）（第 1 组）存在伴发膝关节损伤，184 例患者无伴发膝关节损伤（第 2 组）。第 1 组的平均年龄为 34.3 岁，而第 2 组为 45.4 岁（p=0.021）。模式分析显示 5 例骨折、14 例韧带损伤（PCL 损伤=68%）和 14 例软组织损伤。16 例（48.48%）损伤在住院期间发现，17 例（51.51%）在随访期间发现。膝关节损伤与上肢损伤（OR=3.49，95%CI 1.12-10.00，p=0.022）和其他下肢损伤（OR=3.18，95%CI 1.03-8.95，p=0.032）之间存在关联。