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中华老年骨科与康复电子杂志 ›› 2023, Vol. 09 ›› Issue (04) : 252 -256. doi: 10.3877/cma.j.issn.2096-0263.2023.04.009

综述

漂浮膝损伤的诊治进展
张坤淇, 张睿, 徐佳, 康庆林()   
  1. 200233 上海交通大学医学院附属第六人民医院骨科
  • 收稿日期:2022-05-17 出版日期:2023-08-05
  • 通信作者: 康庆林
  • 基金资助:
    国家自然科学基金(82072421); 上海市自然科学基金(20ZR1442200)

The progress of the management of floating knee injury

Kunqi Zhang, Rui Zhang, Jia Xu, Qinglin Kang()   

  1. Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
  • Received:2022-05-17 Published:2023-08-05
  • Corresponding author: Qinglin Kang
引用本文:

张坤淇, 张睿, 徐佳, 康庆林. 漂浮膝损伤的诊治进展[J/OL]. 中华老年骨科与康复电子杂志, 2023, 09(04): 252-256.

Kunqi Zhang, Rui Zhang, Jia Xu, Qinglin Kang. The progress of the management of floating knee injury[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(04): 252-256.

漂浮膝损伤是一类由高能量暴力引起的同侧股骨、胫骨的骨干或邻近干骺端同时骨折,造成膝关节呈连枷状的严重损伤,具有损伤机制复杂、处理困难、并发症多等特点。膝关节受累与漂浮膝预后相关,故目前常采用Fraser分型系统对漂浮膝损伤分类。由于可合并躯干脏器损伤,接诊此类患者,应首先稳定生命体征、排除或修补内脏损伤后,再着眼患肢功能重建。尽管分期的骨与软组织功能重建手术配合系统的功能锻炼对改善患肢功能疗效显著,但由于损伤严重和存在诸多并发症,漂浮膝损伤的长期随访结果并不乐观。因此,骨科手术医生在治疗此类损伤的同时应积极防治并发症。

Floating knee injury refers to simultaneous diaphyseal or metaphyseal fractures in ipsilateral femur and tibia due to high-energy violence, which results in severe flail knee joint and is characterized by sophisticated mechanisms, tough management and high rate of complications. Because intraarticular injury is associated with the prognosis of floating knee injury, Fraser classification system is now the most widely utilized to classify such injuries. Since concomitant body organ injuries could be life-threatening, stability of vital signs and evaluation and repair of organ injury should be foremost when come up with such victims, to which limb function reconstruction should be secondary. Although staged bone and soft tissue surgical reconstruction along with systemic rehabilitation could improve the function of the injured extremity, results from long-term follow-up do not indicate an optimistic prognosis due to the severity of the injury and multiple complications. Thus, orthopedists should treat such injury with optimal procedures and consider the prevention of complications at the same time.

表1 漂浮膝损伤的不同分型
表2 Karlström-Olerud评分系统[40]
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