创伤性髋关节脱位合并膝关节损伤的临床研究

Knee injury in patients with high-energy traumatic ipsilateral hip dislocation

目的探讨创伤性髋关节脱位中合并的膝关节损伤的发病情况。方法 2004年4月至2010年5月本组共收治创伤性髋关节脱位患者28例,通过同侧膝关节的病史、体格检查和MRI检查,研究所有创伤性髋关节脱位患者同侧膝关节的损伤情况。结果 28例髋关节脱位患者中有21例(75%)同侧膝关节疼痛。体格检查中25例(89%)发现软组织损伤的可见证据,2例(7%)交叉韧带或侧副韧带损伤,10例(36%)膝关节积液,4例(14%)半月板损伤的体征。28例膝关节MRI检查中1例产生伪影予排除,其余27例中有25例MRI上发现异常信号,其中膝关节积液(37%)、骨挫伤(33%)、半月板撕裂(30%)是最常见的异常。结论该研究中发现创伤性髋关节脱位患者合并同侧膝关节损伤的发病率较高,骨挫伤可能为髋关节脱位后同侧膝关节持续性疼痛提供合理解释。本研究推荐常规应用MRI进行膝关节检查,以发现单靠病史和体格检查可能被遗漏的关节内病变。

Objective To observe the incidence of coexistent ipsilateral knee inury in patients with traumatic hip dislocation. Methods From April 2004 to May 2010, the ipsilateral knees in 28 patients who had a traumatic hip dislocation were evaluated prospectively on the basis of a standardized history, physical examination, and magnetic resonance imaging. Results 21 （75%） of the 28 knees were painful. 25 （89%） knees had visible evidence of soft-tissue injury by inspection. As one knee was excluded because of artifacts, magnelic resonance imaging revealed evidence of abnormality in 25 （93%） of the left 27 knees, among which effusion （37%）, bone bruise （33%）, and meniscal tear （30%） were the most common findings. Conclusions The present study provides evidence for a high incidence of associated ipsilateral knee injuries in patients with traumatic hip dislocation. Bone contusion may be a possible explanation for persistent knee pain following a traumatic hip dislocation. Regular use of magnetic resonance imaging is recommanded for the evaluation of these patients in order to detect injury that may not be discoverable by history and physical examination.