目的:膝关节脱位(KD)是复杂的损伤,定义为胫股关节不协调,这导致两个或两个以上的主要稳定膝盖韧带的撕裂,它们通常与周围软组织或神经血管结构的损伤有关。这些损伤的分类系统应简单且可重复,并允许外科医生之间进行沟通以进行手术计划和结果预测。这项研究的目的是制定一系列因素,由高容量的膝盖外科医生优先考虑,这应该包括在KD分类系统中。
方法:全球骨科膝关节手术专家小组参与了Delphi流程。第一项调查雇用了91名整形外科医生,以生成应包括在KD分类系统中的患者和系统特定因素列表,这些因素可能会影响手术计划和结果。随后,来自巴西的27名专家(平均15.3年的经验)(n=9)优先考虑了该列表,美国(n=6),南非(n=4),印度(n=4),中国(n=2),和英国(n=2)。对这些项目进行了分析,以找到至少有70%的共识纳入分类系统的因素。
结果:在确定的12个因素中,4人(33%)对纳入分类系统达成了至少70%的共识.被认为对纳入分类系统至关重要的因素包括血管损伤(89%),腓总神经损伤(78%),韧带撕裂数(78%),开放性损伤(70%)。
结论:在KD分类系统中包含各种因素的共识并不容易达成。参与者的广泛地理分布提供了不同的见解,并使研究结果在全球范围内适用。通过Delphi技术确定的分类系统中包含的最重要因素是血管损伤,腓总神经损伤,韧带撕裂的数量,开放的伤害。迄今为止,Schenck解剖分类系统最准确地识别了这些患者变量,增加了开放性损伤分类.作者建议更新申克分类系统,包括开放性损伤作为额外的修饰符,尽管这只是更新分类的一小步,进一步的研究应评估纳入更先进的成像模式。未来的研究应该集中在将这些因素整合到有用的现有分类系统中,这些分类系统可以预测手术治疗和患者预后。
Knee dislocations (KDs) are complex injuries defined as incongruity of the tibiofemoral joint, which leads to tears of two or more of the main stabilising knee ligaments, and they are often associated with damage to surrounding soft tissue or neurovascular structures. A classification system for these injuries should be simple and reproducible and allow communication among surgeons for surgical planning and outcome prediction. The aim of this study was to formulate a list of factors, prioritised by high-volume knee surgeons, that should be included in a KD classification system.
A global panel of orthopaedic knee surgery specialists participated in a Delphi process. The first survey employed 91 orthopaedic surgeons to generate a list of patient- and system-specific factors that should be included in a KD classification system that may affect surgical planning and outcomes. This list was subsequently prioritised by 27 identified experts (mean 15.3 years of experience) from Brazil (n = 9), USA (n = 6), South Africa (n = 4), India (n = 4), China (n = 2), and the United Kingdom (n = 2). The items were analysed to find factors that had at least 70%
consensus for inclusion in a classification system.
Of the 12 factors identified, four (33%) achieved at least 70%
consensus for inclusion in a classification system. The factors deemed critical for inclusion in a classification system included vascular injuries (89%), common peroneal nerve injuries (78%), number of torn ligaments (78%), and open injuries (70%).
Consensus for inclusion of various factors in a KD classification system was not easily achieved. The wide geographic distribution of participants provides diverse insight and makes the results of the study globally applicable. The most important factors to include in a classification system as determined by the Delphi technique were vascular injuries, common peroneal nerve injuries, number of torn ligaments, and open injuries. To date, the Schenck anatomic classification system most accurately identifies these patient variables with the addition of open injury classification. The authors propose to update the Schenck classification system with the inclusion of open injuries as an additional modifier, although this is only a small step in updating the classification, and further studies should evaluate the inclusion of more advanced imaging modalities. Future research should focus on integrating these factors into useful existing classification systems that are predictive of surgical treatment and patient outcomes.