From the University of Miami Leonard M. Miller School of Medicine (Luxenburg, Syros, and Bondar), and the Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL (Constantinescu, Barnhill, Vanden Berge, and Vilella-Hernandez).
J Am Acad Orthop Surg. 2023 Feb 15;31(4):e198-e206. doi: 10.5435/JAAOS-D-22-00339. Epub 2022 Nov 9.
Multisystem injuries affecting vasculature and nerves can be detrimental sequelae of knee dislocations (KDs). The purpose of this study was to provide an update of the current literature since the conducted search used in the publication of Medina et al on May 3, 2013, to evaluate (1) the frequency of vascular and neurologic injury after KD, (2) the frequency with which surgical intervention was conducted for vascular injury in this setting, and (3) the frequency with which each imaging modality was used to detect vascular injury.
A two-author screening process was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the MEDLINE database. Frequency of vascular injury, surgical intervention, and amputation after KD were analyzed. Diagnostic modalities used in the acute-care setting were also evaluated.
Nineteen articles were analyzed for a total of 37,087 KDs. Of these, 10.7% sustained vascular injuries and 19.6% sustained nerve injuries. Overall, 62.2% of patients with vascular injury underwent surgical repair and 2.2% limbs resulted in amputation. Angiography was the most frequently used diagnostic modality (91.7%).
This review updates our understanding on the clinical implications of KDs including frequency of vascular injury (10.7%), amputation (2.2%), and nerve injuries (19.6%). Compared with prior literature, there was an increased prevalence of KD1 (32.4%) and lateral KDs (80.4%). Most vascular injuries after KD undergo surgical repair (62.2%).
影响血管和神经的多系统损伤可能是膝关节脱位 (KD) 的有害后遗症。本研究的目的是提供自 Medina 等人于 2013 年 5 月 3 日发表以来的最新文献综述，以评估 (1) KD 后血管和神经损伤的频率，(2) 在此情况下对血管损伤进行手术干预的频率，以及 (3) 每种影像学方式用于检测血管损伤的频率。
按照系统评价和荟萃分析的首选报告项目的两项作者筛选流程，使用 MEDLINE 数据库进行筛选。分析了 KD 后血管损伤、手术干预和截肢的频率。还评估了在急性护理环境中使用的诊断方式。
分析了 19 篇文章，共涉及 37087 例 KD。其中，10.7%发生血管损伤，19.6%发生神经损伤。总的来说，62.2%的血管损伤患者接受了手术修复，2.2%的肢体截肢。血管造影是最常用的诊断方式（91.7%）。
本综述更新了我们对 KD 的临床意义的理解，包括血管损伤的频率（10.7%）、截肢（2.2%）和神经损伤（19.6%）。与之前的文献相比，KD1（32.4%）和外侧 KD（80.4%）的患病率有所增加。KD 后大多数血管损伤需要手术修复（62.2%）。
