Walker D M, Kennedy J C
Am J Sports Med. 1980 May-Jun;8(3):172-4. doi: 10.1177/036354658000800305.
Recognition of ligamentous injuries of the knee in the acute phase is essential for optimum treatment and prognosis. A multitraumatized patient with a fractured femur and occult knee ligament damage presents a difficult diagnostic challenge. This paper retrospectively reviews 52 patients with 54 midshaft femoral fractures. The high incidence (48%) of ipsilateral knee ligament damage, particularly of a severe nature (30%) evident at followup (mean 24.5 months) is alarming. In the 26 cases of knee ligament damage, the mean time from injury to documentation of instability is 12.8 months. Motor vehicle and athletic injuries and falls account for all of the injuries. The majority are dashboard impacts treated in balanced traction with subsequent case bracing. The anterior cruciate ligament (50%) is most often injured followed by the medial collateral ligament (31%), lateral collateral ligament (13%), and posterior cruciate ligament (6%). A Lachman test, aspiration of the effusions, examinations under anesthesia including stress films, and arthroscopy are recommended as diagnostic procedures. Acute ipsilateral knee instability is a strong relative indication for primary rigid immobilization of the fracture femur to allow early ligamentous repair.
在急性期识别膝关节韧带损伤对于最佳治疗和预后至关重要。一名股骨骨折且伴有隐匿性膝关节韧带损伤的多发伤患者面临着艰难的诊断挑战。本文回顾性分析了52例患有54处股骨干骨折的患者。同侧膝关节韧带损伤的高发生率（48%），尤其是在随访（平均24.5个月）时明显可见的严重损伤（30%）令人担忧。在26例膝关节韧带损伤病例中，从受伤到记录不稳定的平均时间为12.8个月。所有损伤均由机动车事故、运动损伤和跌倒导致。大多数是仪表板撞击伤，采用平衡牵引治疗，随后使用支具固定。前交叉韧带损伤最为常见（50%），其次是内侧副韧带（31%）、外侧副韧带（13%）和后交叉韧带（6%）。推荐使用拉赫曼试验、抽出积液、麻醉下检查（包括应力位X线片）和关节镜检查作为诊断方法。急性同侧膝关节不稳定是股骨骨折一期坚强固定以利于早期韧带修复的强烈相对指征。
