Merrill K D
Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston.
Orthop Clin North Am. 1994 Oct;25(4):707-13.
Any knee that is dislocated or that has both anterior and posterior cruciates and one collateral ligament torn should be carefully evaluated for neurologic and vascular injury. Reduction and immobilization should be performed. If the pulses are anything but normal, arrangements should be made to proceed to the operating room immediately. A one-shot arteriogram can be obtained in the operating room, but proceeding directly with popliteal artery exploration is reasonable if the pulses have not returned to normal. If the pulses have returned to normal, an arteriogram should be obtained. After the vascular repair has been done, a fasciotomy of the lower leg should be performed. In the young healthy active patient who does not have significant necrotic muscle or severe nerve injury, delayed reconstruction and early, very aggressive rehabilitation is recommended. Whether this treatment improves the results of this injury remains to be seen. Discussion with the vascular surgeon concerning the use of a tourniquet is recommended. If not functioning, the peroneal nerve is often severely stretched, and no treatment to date has been very encouraging. An ankle foot orthosis or tendon transfers to achieve dorsiflexion may be needed.
任何发生脱位的膝关节，或者前后交叉韧带及一侧副韧带均撕裂的膝关节，都应仔细评估有无神经和血管损伤。应进行复位和固定。如果脉搏不正常，应立即安排前往手术室。可在手术室进行一次性动脉造影，但如果脉搏仍未恢复正常，直接进行腘动脉探查是合理的。如果脉搏已恢复正常，则应进行动脉造影。血管修复完成后，应进行小腿筋膜切开术。对于没有明显坏死肌肉或严重神经损伤的年轻健康活跃患者，建议进行延迟重建和早期、非常积极的康复治疗。这种治疗方法是否能改善该损伤的结果还有待观察。建议与血管外科医生讨论使用止血带的问题。如果腓总神经无功能，通常会严重拉伸，迄今为止尚无非常令人鼓舞的治疗方法。可能需要使用踝足矫形器或进行肌腱转移以实现背屈。
