目的:膝关节脱位后对the动脉的损伤,如果不及时诊断和适当治疗,可能会有毁灭性的结果。这项回顾性研究的目的是描述我们使用的诊断和治疗方案,以及为在我们三级医院接受治疗的一系列患者提供长期结果,强调踝臂指数(ABI)测量作为诊断方法不可或缺的组成部分的重要性。
方法:对1996年11月至2023年7月期间所有入院者进行回顾性分析,诊断为膝关节脱位以及是否存在由钝性高能量创伤引起的伴随动脉损伤,进行了。在2006年之前,数字减影血管造影(DSA)和/或计算机断层扫描血管造影(CTA)是诊断方法的一部分(A组)。2006年后,踝臂指数(ABI)被用作诊断动脉损伤的一线测试(B组)。选择Tegner和Lysholm评分来评估组间患者的术后损伤,还要考虑是否存在血管损伤。Mann-WhitneyU检验和单变量方差分析用于得分的统计分析。
结果:总体而言,55名患者被确认,其中21人(38.2%)的the动脉受伤,所有这些都用反向大隐静脉旁路术治疗。在21名患者中,4人(4.3%)出现骨筋膜室综合征,用筋膜切开术治疗,1条腿(1.8%)在膝盖以上截肢。没有病人失去随访,除了一个(95%)的血管修复仍然是专利,平均随访6年,四肢无缺血征象。A组和B组之间的Tegner和Lysholm评分平均值相似,并且与血管损伤的存在和所使用的诊断方案无关。有趣的是,ABI低于0.9被证明是动脉损伤的预测因素.
结论:应该对the动脉损伤的存在有较高的认识,并且在所有膝关节脱位病例的治疗中应常规进行ABI测量。这边,更少的患者会进行不必要的CTA扫描,而且几乎没有任何动脉损伤会丢失,正如我们的研究所建议的那样。
BACKGROUND: Injury to the popliteal artery after knee dislocation, if not promptly diagnosed and properly treated, can have devastating results. The purpose of this retrospective study was to describe the diagnostic and the treatment protocol we use, as well as provide long-term outcomes for a series of patients treated in our tertiary hospital, emphasizing on the importance of ankle-brachial index (ABI) measurement as an integral component of the diagnostic approach.
METHODS: A retrospective analysis of all admissions to our hospital trauma center between November 1996 and July 2023, with a diagnosis of knee dislocation and the presence or absence of concomitant arterial injury resulting from blunt high-energy trauma, was conducted. Before 2006, digital subtraction angiography (DSA) and/or computed tomography angiography (CTA) were part of the diagnostic approach (group A). After 2006, the ABI was used as a first-line test to diagnose arterial damage (group B). The Tegner and Lysholm scores were chosen to assess patients\' postoperative impairment between groups, taking also into account the presence or absence of vascular injury. The Mann-Whitney U test and a univariate analysis of variance were used for the statistical analysis of scores.
RESULTS: Overall, 55 patients were identified, and 21 of them (38.2%) had injuries to the popliteal artery, all of which were treated with a reversed great saphenous venous bypass. Out of the 21 patients, 4 (4.3%) developed compartment syndrome, which was treated with fasciotomies, and 1 leg (1.8%) was amputated above the knee. With no patients lost to follow-up, all but one (95%) of the vascular repairs are still patent, and the limbs show no signs of ischemia after a mean follow-up of 6 years. The Tegner and Lysholm score means were similar between groups A and B and independent of the presence of vascular injury and the diagnostic protocol used. Interestingly, an ABI below 0.9 proved to be predictive of arterial injury.
CONCLUSIONS: A high level of awareness for the presence of popliteal artery injury should exist and an ABI measurement should be routinely performed in the management of all cases of knee dislocation. This way, fewer patients will undergo unnecessary CTA scanning, and hardly any popliteal artery injuries can go missing, as suggested by our study.