创伤性膝关节脱位失稳性的临床诊治

Diagnosis and treatment of unstable traumatic knee dislocation

目的探讨创伤性膝关节脱位失稳性的临床诊治。方法笔者随机选取2008年1月~2015年5月收治的80例创伤性膝关节脱位失稳性患者,依据膝关节脱位损伤类型及收治时间（伤后≥15d或〈15d）分两组,即新鲜损伤组（n=40）和陈旧损伤组（n=40）。应用浮髌试验、抽屉试验、CT、膝应力位X线检查等对两组患者的患膝进行检查,依据两组患者的实际病情给予单纯开放手术、单纯关节镜手术、开放手术联合关节镜手术、截肢、全膝关节置换等治疗。结果组内比较,两组患者治疗后的Lysholm膝关节评分均显著高于治疗前（P〈0.05）;组间比较,治疗前两组患者的Lysholm膝关节评分之间的差异不显著（P〉0.05）,治疗后新鲜损伤组患者的Lysholm膝关节评分显著高于陈旧损伤组（P〈0.05）;新鲜损伤组患者膝关节功能恢复的优良率80.0%（32/40）显著高于陈旧损伤组45.0%（18/40,P〈0.05）,术后不良反应发生率17.5%（7/40）低于陈旧损伤组32.5%（13/40,P〉0.05）。结论创伤性膝关节脱位失稳性的临床诊治宜早不宜晚,最好在15d内诊治。

Objective To investigate the clinical diagnosis and treatment of unstable traumatic knee dislocation. Methods Eighty cases of unstable traumatic knee dislocation treated in our hospital from Jan. 2008 to May2015 were randomly selected,and were divided into fresh injury group（ n = 40） and old injury group（ n = 40） according to the knee dislocation injuries type. Floating patella test,drawer test,CT,X-ray examination were applied to the suffering knees of the two groups. Simple open surgery,simple arthroscopic surgery,open joint arthroscopic surgery,amputation and total knee replacement therapy were performed based on the actual conditions. Results The Lysholm knee score after treatment in the two groups were significantly higher than before treatment（ P 0. 05）; before treatment,the difference of the Lysholm knee score was not significant between the two groups（ P 0. 05）,the Lysholm knee score after treatment in the fresh injury group was significantly higher than that of the old injury group（ P 0. 05）; the excellent and good rate of knee function recovery in the fresh injury group was 80. 0%（ 32 /40）,which was significantly higher than that in the old injury group of 45. 0%（ 18 /40,P 0. 05）; the incidence of adverse reactions after treatment in the fresh injury group was 17. 5%,which was lower than that in the old injury group（ 32. 5%,P 0. 05）. Conclusion Unstable traumatic knee dislocation should be diagnosed and treated as early as possible,better in 15 days after injury.