Srimongkolpitak Surasak, Chernchujit Bancha
Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand.
Department of Orthopaedics, Faculty of Medicine, Thammasat University, Bangkok, Thailand.
Indian J Orthop. 2024 Jul 4;58(9):1196-1205. doi: 10.1007/s43465-024-01220-5. eCollection 2024 Sep.
Vascular injuries are rarely associated with severe knee injuries; nonetheless, it is imperative to efficiently detect this condition and plan for either immediate or definitive treatment at later stages. The diagnosis and management of multiligament knee injuries still present unresolved issues, particularly in the early detection of vascular issues and the sequential stabilisation of ligaments. High-energy trauma is a frequently encountered cause, however, even low-energy trauma in those who are morbidly obese might pose a significant risk. Advancements in detection and management methods have greatly decreased the occurrence of vascular complications and amputation rates over time. MLKIs after transient knee dislocations are frequently misdiagnosed for vascular injuries, underscoring the necessity for improved diagnostic techniques to avoid avoidable amputations.
This article is a new conceptual review of vascular injuries associated with MLKIs. It provides a full overview of these conditions and includes a review of the most recent literature. We have included pertinent citations from the literature, together with suggestions derived from the latest studies. This review article had additional evaluation by proficient specialists with commendable outcomes and more than a decade of expertise in surgical techniques.
This article offers a detailed overview of orthopaedic management, including new definitions and summaries of the causes, evaluation of patients, clinical assessment, identification of vascular injuries, and initial management in patients with vascular impairment following major limb and joint injuries (MLKIs).
MLKIs (patients with lower limb ischaemia) who have vascular damage necessitate meticulous physical assessment and sophisticated treatments in order to decrease amputation rates. Prompt identification and timely treatment of vascular lesions, namely in the popliteal artery, can substantially reduce the occurrence of amputations. Emerging research suggests that there is a heightened risk in low-energy situations, particularly amongst individuals who are extremely obese. Progress in vascular intervention has led to a reduction in amputation rates, whilst the implementation of new guidelines has enhanced identification. Thorough patient assessment is essential, utilising physical examinations and imaging techniques such as Computed tomography angiography, magnetic resonance angiography (CTA or MRA) to guide treatment decisions. MRA, in particular, is capable of identifying both vascular and knee structural damage.
Level IV, Literature reviews.
血管损伤很少与严重的膝关节损伤相关；尽管如此，必须有效检测这种情况，并为后期的即时治疗或确定性治疗制定计划。多韧带膝关节损伤的诊断和管理仍然存在未解决的问题，特别是在血管问题的早期检测和韧带的顺序稳定方面。高能量创伤是常见原因，然而，即使是病态肥胖者的低能量创伤也可能带来重大风险。随着时间的推移，检测和管理方法的进步大大降低了血管并发症的发生率和截肢率。短暂性膝关节脱位后的多韧带膝关节损伤（MLKIs）经常被误诊为血管损伤，这凸显了改进诊断技术以避免不必要截肢的必要性。
本文是对与MLKIs相关的血管损伤的新的概念性综述。它全面概述了这些情况，并包括对最新文献的综述。我们纳入了文献中的相关引用，以及最新研究得出的建议。这篇综述文章由精通手术技术、拥有超过十年专业经验且成果斐然的专家进行了额外评估。
本文详细概述了骨科管理，包括新的定义以及对主要肢体和关节损伤（MLKIs）后血管损伤的原因、患者评估、临床评估、血管损伤识别和初始管理的总结。
有血管损伤的MLKIs（下肢缺血患者）需要细致的体格检查和复杂的治疗，以降低截肢率。及时识别和治疗血管病变，特别是腘动脉的病变，可大幅减少截肢的发生。新出现的研究表明，在低能量情况下风险更高，尤其是在极度肥胖的个体中。血管介入的进展导致截肢率降低，而新指南的实施提高了识别能力。全面的患者评估至关重要，利用体格检查和计算机断层血管造影、磁共振血管造影（CTA或MRA）等成像技术来指导治疗决策。特别是MRA能够识别血管和膝关节结构损伤。
四级，文献综述。
