Zuhosky J P, Dugan S A, Young J L, Bode R K, Kelly J P
Department of Physical Medicine and Rehabilitation, Northwestern University Medical School, Chicago, IL, USA.
Arch Phys Med Rehabil. 1998 Jul;79(7):805-10. doi: 10.1016/s0003-9993(98)90360-4.
To estimate the incidence of ligamentous knee injuries in patients with traumatic brain injury (TBI) involved in pedestrian versus motor vehicle collisions (PVMVC), to identify associated risk factors, and to compare rehabilitation outcomes and costs in TBI patients with and without ligamentous knee injury.
Retrospective, case control.
An academic rehabilitation hospital with a large metropolitan referral base.
Twenty-three consecutive adolescent and adult subjects admitted for acute inpatient rehabilitation after a PVMVC from January 1, 1994, to January 1, 1996.
Five subjects (22%) were found to have a ligamentous knee injury, one with bilateral injuries. Two of these six injuries were diagnosed only after presentation to the rehabilitation setting. The most common injury was an anterior cruciate ligament (ACL) disruption in 5 of 6 knees. A coupled ACL and medial collateral ligament injury was identified in 4 of 6 injured knees. The risk of ligamentous knee injury was most closely associated with the presence of a tibial plateau fracture (n=3) (chi2=12.420, p < .001). There was no statistical difference between groups with and without ligamentous knee injuries with respect to age, gender, inpatient acute or rehabilitation length of stay, admission, discharge, or change in motor Functional Independence Measure (FIM) interval measures, or rehabilitation costs. Four of the 5 patients with ligamentous knee injuries were successfully managed nonoperatively. A case illustrating longitudinal management is presented.
TBI and ligamentous knee injuries, in particular ACL injuries, are common comorbidities after PVMVC. Physicians must maintain a high index of suspicion for ligamentous knee injuries in this population, particularly when a tibial plateau fracture is present. TBI patients with and without ligamentous knee injuries can have comparable functional outcomes when the ligament injuries are identified and appropriately managed, without incurring undue cost or length of inpatient rehabilitation.
评估在行人与机动车碰撞（PVMVC）所致创伤性脑损伤（TBI）患者中膝关节韧带损伤的发生率，确定相关危险因素，并比较有无膝关节韧带损伤的TBI患者的康复结局及费用。
回顾性病例对照研究。
一家拥有大量大都市转诊基础的学术康复医院。
1994年1月1日至1996年1月1日因PVMVC后接受急性住院康复治疗的23例连续的青少年和成年受试者。
发现5例受试者（22%）有膝关节韧带损伤，其中1例为双侧损伤。这6处损伤中有2例是在进入康复机构后才被诊断出来的。最常见的损伤是6例膝关节中有5例发生前交叉韧带（ACL）断裂。6例受伤膝关节中有4例同时存在ACL和内侧副韧带损伤。膝关节韧带损伤的风险与胫骨平台骨折（n = 3）的存在密切相关（χ2 = 12.420，p <.001）。有无膝关节韧带损伤的两组在年龄、性别、住院急性或康复住院时间、入院、出院或运动功能独立性测量（FIM）间隔测量的变化或康复费用方面无统计学差异。5例膝关节韧带损伤患者中有4例通过非手术治疗成功治愈。文中给出了一个说明纵向管理的病例。
TBI和膝关节韧带损伤，尤其是ACL损伤，是PVMVC后的常见合并症。医生必须对该人群中的膝关节韧带损伤保持高度怀疑指数，特别是当存在胫骨平台骨折时。当韧带损伤得到识别并得到适当处理时，有无膝关节韧带损伤的TBI患者可以有可比的功能结局，而不会产生不必要的费用或住院康复时间。
