膝关节脱位后多韧带膝关节损伤的外固定架应用、两期手术和术后感染风险较高

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-04-01 DOI:10.1016/j.asmr.2024.101070

Adam V. Daniel M.D., Taylor A. Johnson M.D., Katherine F. Druskovich M.D., Warren A. Williams M.D., Daniel Miller M.D., Stanley J. Kupiszewski M.D.

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引用次数: 0

摘要

目的探讨膝关节脱位与非脱位患者多韧带膝关节损伤（MLKIs）手术治疗后的预后。方法2008年至2021年间接受mlki手术治疗的患者纳入本研究。患者被分为两组：有坦白性膝关节脱位（KD），通过x线片或急诊复位记录诊断的患者，以及没有坦白性膝关节脱位（非KD）的患者。收集了以下患者报告的结果测量：疼痛的视觉模拟量表，国际膝关节文献委员会主观评分和Lysholm膝关节评分量表。其他手术，如翻修韧带重建和并发症，如感染和关节纤维化也被获得。结果共88例患者(88膝；36名KD vs 52名非KD)被纳入最终分析。本研究纳入女性30例，男性58例，平均年龄34.3±12.7岁（范围10 ~ 61岁）。未接受翻修手术的患者平均随访时间为9.2年（3.4-15.3年）。两组患者在年龄、性别、损伤机制、半月板/软骨损伤或神经血管状态等方面均无差异。此外，在视觉模拟量表、国际膝关节文献委员会或Lysholm评分方面也没有差异。KD组患者KD分级较高（KD III-KD V, 29 [81%] vs 21 [40%]）；P & lt;.001)，非KD组KD I损伤明显更多(48.1% vs 11.1%, P <；措施)。KD组更多的患者接受了分期手术(69.4% vs 28.8%, P <；.001)并应用外固定架(50% vs 5.8%, P <；措施)。两组之间的总并发症发生率相当，翻修手术或关节纤维化无差异；而KD组术后感染率较高（16.7% vs 1.9%, P = 0.017）。结论与无KDs的患者相比，经历过KDs的患者接受外固定的几率增加，经历分阶段手术的几率增加，损伤程度更高，术后感染风险更高。在最后的随访中，两组患者报告的结果没有差异。证据水平：III级，回顾性队列研究。

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External Fixator Application, 2-Stage Procedures, and Postoperative Infection Risk Are Higher in Multiligamentous Knee Injuries After Frank Knee Dislocations

Purpose

To examine outcomes after surgical treatment of multiligamentous knee injuries (MLKIs) in patients with dislocated versus non-dislocated knees.

Methods

Patients who were surgically treated for MLKIs between 2008 and 2021 were included in this study. Patients were divided into 2 groups: those with a frank knee dislocation (KD), diagnosed by radiographs or reduction notes in the emergency department, and those without a frank KD (non-KD). The following patient-reported outcome measures were collected: visual analog scale for pain, International Knee Documentation Committee subjective score, and Lysholm knee scoring scale. Additional procedures such as revision ligamentous reconstruction and complications such as infection and arthrofibrosis were also obtained.

Results

A total of 88 patients (88 knees; 36 KD vs 52 non-KD) were included in the final analysis. This study included 30 female and 58 male patients, and the mean age was 34.3 ± 12.7 years (range, 10-61 years). The mean follow-up period for the patients who did not receive revision surgery was 9.2 years (range, 3.4-15.3 years). There were no differences in age, sex, mechanism of injury, meniscal/chondral injury, or neurovascular status between the groups. Furthermore, there were no differences in visual analog scale, International Knee Documentation Committee, or Lysholm scores. Significantly more patients in the KD group showed higher KD grades (KD III–KD V, 29 [81%] vs 21 [40%]; P < .001), and significantly more KD I injuries were observed in the non-KD group (48.1% vs 11.1%, P < .001). More patients in the KD group underwent staged procedures (69.4% vs 28.8%, P < .001) and had external fixators applied (50% vs 5.8%, P < .001). The overall complication rate was comparable between groups, with no differences in revision surgery or arthrofibrosis; however, the KD group had a higher postoperative infection rate (16.7% vs 1.9%, P = .017).

Conclusions

Patients who experienced frank KDs showed an increased odds of receiving external fixation, showed an increased odds of undergoing a staged procedure, had higher grades of injury, and had a higher risk of postoperative infection compared with those without KDs. At final follow-up, no differences in patient-reported outcomes were noted between the 2 groups.