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A luxação traumática do joelho

Revisão
Authors: Azevedo, Ana Filipa Costa Pereira Reis de;

A luxação traumática do joelho

Abstract

Introdução: A luxação traumática do joelho é uma lesão rara, porém pode ameaçar a viabilidade do membro afectado. Por vezes, esta situação não é correctamente diagnosticada, devido à ocorrência de redução espontânea ou no local do acidente. Encontra-se também associada a lesões neurovasculares. Actualmente, assuntos como o uso da arteriografia, a opção terapêutica e temáticas inerentes a esta, bem como, os programas de reabilitação aplicados têm suscitado grande controvérsia. A presente dissertação pretende efectuar uma revisão da literatura no âmbito da luxação traumática do joelho, procurando esclarecer alguns dos pontos de debate, assim como, efectuar a análise comparativa das diversas modalidades de tratamento. Métodos: Foram pesquisados nas bases Cochrane, E-medicine, LILACS, Medline, Pubmed, Uptodade e na biblioteca electrónica conjunta da Faculdade de Medicina da Universidade do Porto e do Hospital de São João no Porto (Portugal), entre Janeiro de 1950 e Fevereiro de 2008, artigos publicados usando a palavra-chave “knee dislocation”. Após três fases de avaliação dos artigos, foram seleccionados 17 estudos para a presente análise. Resultados: Os estudos apontam para a divergência dos procedimentos terapêuticos. Os parâmetros com resultados favoráveis foram: a abordagem cirúrgica, o tempo cirúrgico inferior a três semanas e a realização da reconstrução de ambos os ligamentos cruzados. A reparação directa dos ligamentos cruzados foi não recomendada. A complicação mais relevante foi a artrofibrose. Conclusão: A luxação do joelho é uma situação rara, mas grave. Na avaliação do estado vascular deve recorrer-se à arteriografia de modo selectivo. O diagnóstico e tratamento correctos e atempados, conduzem a um melhor prognóstico. A redução da luxação deve ser imediata. Em indivíduos jovens e/ou activos, a modalidade cirúrgico é preferido. No entanto, ainda permanecem dúvidas em relação ao tratamento. A reabilitação com início precoce está recomendada.

Introduction: The traumatic knee dislocation is a rare injury, but can be limb-threatening. Sometimes, this is not properly diagnosed, due to the occurrence of spontaneous reduction or in the place of the accident. It is also associated with neurovascular injuries. Currently, such matters as the use of angiography, a therapeutic option and topics related to this, and rehabilitation programmes have aroused great controversy. This dissertation intends to conduct a review of literature in the context of traumatic knee dislocation, trying to clarify some points of debate, as well as make a comparative analysis of different forms of treatment. Methods: We searched the Cochrane, e-medicine, LILACS, Medline, Pubmed and Uptodade databases and the electronic library of the Faculty of Medicine of the University of Oporto and the Hospital of St. John (Oporto, Portugal), between January 1950 and February 2008, for published articles using the keyword "knee dislocation". After three stages of articles assessment, 17 studies were selected for this review. Results: The studies point to the divergence of therapeutic procedures. The parameters with favourable results were: a surgical approach, the surgical time less than three weeks and the reconstruction of both cross ligaments. The repair of direct cross ligaments was not recommended. The complication most relevant was artrofibrose. Conclusion: Knee dislocation is a rare situation, but serious. In assessing the vascular state, selective arteriography is recommended. The correct and prompt diagnosis and treatment leads to a better prognosis. The reduction of dislocation must be immediate. In young and/or active individuals, the surgical method is preferred. However, doubts still remain regarding the treatment. The early rehabilitation is recommended.

Related Organizations
Keywords

Luxação do joelho, Luxação do joelho - Angiografia, Luxação do joelho - Tratamento

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citations
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popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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