严重膝关节脱位伴多韧带损伤的早期处理

Early treatment of severe dislocation of the knee joint combined with multiple ligament injure

目的回顾性分析严重膝关节脱位伴多韧带损伤的早期处理。方法 2009年至2013年收治严重膝关节脱位伴多韧带损伤患者12例,每例患者均有3根韧带损伤,其中男9例,女3例。运动伤4例,高处坠落伤3例,重物砸伤3例,车祸2例。5例为开放性损伤,3例并腓总神经损伤,2例并腘动脉损伤;总结分析患者入院时的各种并发症（关节脱位、神经血管损伤、开放切口等）及其早期处理方法。结果所有患者均获8个月~5年随访。4例患者早期开放性切口Ⅰ期愈合,1例患者切口局部皮肤坏死不愈合,后经扩创缝合愈合良好;二期重建韧带手术切口均Ⅰ期愈合;无切口感染。2例患者合并腘动脉损伤,均给予血管探查,1例行血管移植,1例行局部血管吻合,术后成活良好。3例腓总神经损伤者均未给予手术处理,复位后应用营养神经药物,1~3个月恢复正常。所有患者均获得良好的早期复位及正常的下肢力线,1例患者因多次转院,髌骨未予复位,3周后已不能完全复位,强行克氏针固定加石膏固定维持力线,后二期手术重建韧带时经外侧髌旁韧带松解,获得正常的髌股关节轨迹。二期手术重建后,根据Lysholm膝关节功能评分标准评定：优7例,良3例,可2例,优良率为83.3%。结论严重的膝关节脱位伴多韧带损伤的早期处理,为二期关节镜下韧带重建创造了良好的条件,避免了许多早晚期并发症的发生。

Objective To retrospectively analyze the early treatment of severe knee joint dislocation with multiple ligament injury. Methods From 2009 to 2013,twelve patients with severe knee joint dislocation combined with multiple ligament injury were selected,each patient had 3 ligaments injury,male 9 cases,female 3 cases. Sport injury in 4 cases,falling injury in 3 cases,bruise in 3 cases,traffic accident in 2 cases. Five cases were open injury,3 cases with common peroneal nerve injury,2 cases with popliteal artery injury. The various complications（ joint dislocation,nerve and blood vessel injury,open wound,etc.） of patients and early treatment of these complications were summarized and analyzed. Results All patients were followed up for 8 months to 5years. Four cases of early wound were healed,1 case with local skin wound were healed after debridement and suture. After the second stage reconstruction of ligament,all incisions were healed without infection. Two patients combined with popliteal artery injury were treated by vascular exploration,1 case of vascular graft and 1 case of local vascular anastomosis,the postoperative survival was good. Three cases of common peroneal nerve injury were not given operation treatment,application of neurotrophic drugs after reset,1 to 3 months back to normal. All patients obtained a good reduction and normal limb alignment,1 patient＇s patella did not reset cause by the number of transfers,and it was not completely reset after 3 weeks. The patient taken the normal track of patellofemoral joint after taken Kirschner wire and plaster fixation to maintain the limb alignment,and the second stage of operation for ligament reconstruction. After the second stage of operation for reconstruction,according to the Lysholm knee functional score standard assessment： excellent in 7 cases,good in 3 cases and acceptable in 2 cases,the excellent and good rate was 83. 3%.Conclusion Early treatment of severe dislocation of the knee joint combined with multiple ligament injury,creating good conditions for the second stage of ligament reconstruction under arthroscopy,avoided many of early and late complications.