膝关节多发韧带损伤的损伤控制治疗策略.pdf

膝关节多发韧带损伤治疗的 损伤控制策略 Strategy for the Treatment to KD / MLIK DCO vs ETC 青岛 解放军第401医院骨科 徐青镭 李飞 卢廷胜 XU Qinglei, LI Fei, LU Tingsheng PLA 401 Hospital, QINGDAO Multiple Ligament Injured Knees （MLIK） from Knee Dislocations (KDs) 膝关节多发韧带损伤多继发于 膝关节脱位后 •罕见但病情严重 •急性期多见于急诊 •慢性多见于门诊 •50% 的急性膝关节脱位在第一创伤现场获 得复位 •主要表现为疼痛、肿胀和膝关节严重积血 病因学 Etiology • Hi-energy mechanisms 高能损伤 common 多见 • Low-energy mechanisms 低能损伤 possible athletics 相对少见、主要发生于运动员 • Ultra low-velocity mechanisms 极低能量损伤 falls in the morbidly obese 见于严重肥胖者的摔倒 Schenck分类 Stannard JP, et al. JBJS, 2004;86A:910–915 ABI, ankle-brachial index • ABI = doppler systolic arterial BP injured / uninjured • PE of pulses alone is not sensitive enough. • ABI of 0.9 has 95% sensitivity and 97% specificity for clinically significant arterial disruptions. CTA • 25-yo male • complete ACL PCL LCL PLC MCL tears • palpable pulses • ABI 0.58 • arterial injury by CTA CPP, common peroneal palsy 腓总神经损伤 • incidence 14-25% • 62% KD with arterial injuries also had peroneal neuropraxias Harborview algorithm for vascular injury after KD 胫骨平台边缘性骨折 Marginal tibia plateau fx Comminuted tibial eminences, lateral plateau and fibula fx 胫骨髁间棘、外侧胫骨平台以及 腓骨粉碎性骨折 Management of multiple extremity injury • 1970s conservative treatment Management of multiple extremity injury • 1976- early total care, ETC • mainstay in the 1980s-1990s • immediate fixation of all fxs • Allow