膝关节多韧带损伤诊治研究进展
简介
该综述系统总结了多发膝关节韧带损伤（MLKI）的病因、分型、诊断、治疗与康复进展。急性损伤按ATLS原则优先评估，慢性损伤以体格检查为主，MRI结合应力位X线可提高诊断准确性；手术治疗优于保守治疗，早期手术改善功能但增加关节僵硬风险，移植物选择与重建顺序尚无统一共识。康复期约9~12个月，铰链式外固定架可降低重建失败率，个体化康复是改善预后的关键，但手术时机…
英文摘要
OBJECTIVE: To summarize the research progress in the diagnosis and treatment of multiple ligament knee injuries (MLKI). METHODS: Domestic and international literature related to MLKI in recent years was retrieved, and a systematic summary and analysis were conducted from the aspects of etiology, classification, diagnosis, treatment, and rehabilitation. RESULTS: High-energy trauma is the main cause of MLKI, while low-energy and ultra-low-speed injuries also require attention; ultra-low-speed injuries are more common in obese individuals with a higher risk of complications. The Schenck classification is the most widely used in clinical practice, but it has limitations in describing injury energy and evaluating fracture-dislocations. The diagnosis of MLKI should follow the principle of separate management for acute and chronic conditions: acute injuries should be preferentially evaluated in accordance with Advanced Trauma Life Support principles, and chronic injuries are preferably assessed by physical examination. MRI combined with stress radiography can improve diagnostic accuracy, and neurovascular injuries such as popliteal artery and common peroneal nerve injuries should be vigilant. Surgical treatment is the mainstream treatment for MLKI, with better efficacy than nonoperative treatment. Early surgery can improve joint function but increases the risk of joint stiffness; no unified consensus has been reached on graft selection and the sequence of ligament reconstruction. The rehabilitation period of MLKI is about 9-12 months, with non-weight bearing for 4-6 weeks postoperatively and early mobilization as the core principles. The application of hinged external fixators can reduce the failure rate of ligament reconstruction. Early mobilization strategy is superior to delayed mobilization but does not reduce the rate of arthrolysis, and rehabilitation programs should be individualized. CONCLUSION: Basic consensus has been formed on the fundamental diagnosis and treatment principles of MLKI in clinical practice. Surgery combined with individualized rehabilitation is the key to improving prognosis. However, controversies still exist in key aspects such as surgical timing, graft selection and rehabilitation strategies, and the level of existing evidence-based evidence needs to be improved. Large-sample, multicenter prospective studies are urgently needed in the future to promote the development of precise and standardized diagnosis and treatment of MLKI.