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创伤性膝关节脱位的临床、功能和患者报告结局:一项回顾性队列研究,共纳入 75 例患者,随访 6.5 年。

Clinical, functional, and patient-reported outcome of traumatic knee dislocations: a retrospective cohort study of 75 patients with 6.5-year follow-up.

机构信息

Department of Orthopaedic Surgery, Aalborg University Hospital, 18-22 Hobrovej, DK-9000, Aalborg, Denmark.

Karolinska Institutet/Sports Trauma Research Center, Stockholm, Sweden.

出版信息

Arch Orthop Trauma Surg. 2023 May;143(5):2589-2597. doi: 10.1007/s00402-022-04578-z. Epub 2022 Aug 16.

Abstract

INTRODUCTION

At present, limited knowledge regarding clinical, functional, and patient-reported outcomes at mid- and long-terms after surgical treatment of traumatic knee dislocations is available. This study aimed to investigate the mid-term recovery regarding clinical, functional, and patient-reported outcomes in patients following knee dislocation with associated multi-ligament injuries.

MATERIALS AND METHODS

The study design was a cross-sectional cohort study. Data were collected by retrospective chart review, clinical examination, and interview of patients. All patients treated surgically following a knee dislocation between January 2000 and December 2011 were included. The surgical technique was up to the decision of the individual surgeon. The main outcome was the Lysholm knee score. Secondary outcomes consist of clinical knee examination, functional performance test, pain, and patient-reported outcome across several domains in function, sport, pain, and quality of life.

RESULTS

Seventy-five patients (66.3%) accepted the invitation to participate. The mean age at the time of knee dislocation was 33.5 years, with a range of 16-65 years of age. The mean follow-up time was 78 months (R: 17-147). 75% of patient a Schenck's type 1 lesion and 23% a type 3. The median Lysholm knee score was 83 (R: 18-100). The mean KOOS for the five subscales were pain 84.5 (95% CI 80.5-88.5), symptoms 75.1 (95% CI 70.7-79.4), ADL 87.0 (95% CI 83.1-90.9), sport 59.9 (95% CI 53.3-66.4), and QOL 71.3 (95% CI 67.0-75.6). The mean Tegner activity level was 5.1 (95% CI 4.5-5.7). The median single assessment numeric evaluation (SANE) was 93 (R: 0-100). The pain intensity score for pain (VAS) during activity was reported with a mean of 2.7 (95% CI 2.1-3.3). The objective IKDC examination showed 76% of patients grouped by Grade A (normal knee function) or Grade B (nearly normal).

CONCLUSION

With a mean follow-up of 6.5 years, combined repair and reconstruction surgery following a knee dislocation shows good to excellent patient-reported outcome and more than 75% of patients experiencing normal knee functioned evaluated by the IKDC score.

摘要

简介

目前,关于创伤性膝关节脱位手术后中、长期的临床、功能和患者报告结果的知识有限。本研究旨在调查膝关节脱位伴多发韧带损伤患者的中期恢复情况,包括临床、功能和患者报告结果。

材料和方法

研究设计为横断面队列研究。数据通过回顾性病历审查、临床检查和患者访谈收集。纳入 2000 年 1 月至 2011 年 12 月期间接受手术治疗的所有膝关节脱位伴多发韧带损伤患者。手术技术由每位医生决定。主要结局是 Lysholm 膝关节评分。次要结局包括临床膝关节检查、功能表现测试、疼痛以及功能、运动、疼痛和生活质量等多个领域的患者报告结果。

结果

75 名患者(66.3%)接受了邀请参与研究。膝关节脱位时的平均年龄为 33.5 岁,年龄范围为 16-65 岁。平均随访时间为 78 个月(R:17-147)。75%的患者为 Schenck 1 型损伤,23%为 3 型损伤。Lysholm 膝关节评分为 83 分(R:18-100)。五个亚量表的 KOOS 平均得分分别为疼痛 84.5(95% CI 80.5-88.5)、症状 75.1(95% CI 70.7-79.4)、ADL 87.0(95% CI 83.1-90.9)、运动 59.9(95% CI 53.3-66.4)和 QOL 71.3(95% CI 67.0-75.6)。Tegner 活动水平平均为 5.1(95% CI 4.5-5.7)。单一评估数字评估(SANE)中位数为 93(R:0-100)。活动时疼痛强度评分(VAS)的平均报告值为 2.7(95% CI 2.1-3.3)。客观 IKDC 检查显示 76%的患者为 A 级(正常膝关节功能)或 B 级(接近正常)。

结论

在平均随访 6.5 年时,膝关节脱位后的联合修复和重建手术显示出良好到极好的患者报告结果,超过 75%的患者根据 IKDC 评分报告正常膝关节功能。

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