闭合性四肢动脉伤

ClosedArterialInjuriesoftheinLimbs

３３年来，我所收治四肢动脉伤２６９例，其中闭合性动脉伤２８例，占１０．４％。本组病例均有合并伤，其中合并骨折的占６４．３％，脱位１４．３％，周围神经伤、伴行静脉伤、肌肉严重挫伤各占３９．３％。５０％病例伤后２４小时以上才手术处理。本组无１例死亡，截肢９例，占３２．１％。闭合性动脉伤均为钝性损伤，受伤机制复杂，损伤严重，合并伤多，因无伤口，无外出血，临床表现隐蔽，易延误诊治，截肢率高。作者强调，早期正确诊断，争取伤后１２小时内处理血管，恢复肢体血循环，是挽救肢体的关键。同时，要认真处理好合并伤和深筋膜切开术。

Duringthepast33years,269casesofarterialinjuriesofthelimbsweretreated,ofthem28(10.4%)wereclosedinjuriese.Theassociatedconditionsincludiedfractures(64.3%),disloca-tions(14.3%),peripheralnerveinjuries(39.3%),concomitantvenousinjuries(39.3%),severemus-cularansofttissuecontusions(39.3%).Thetimebetweenthemomentofinjuryandsurgicalmanage-mentwasover24hoursin50%ofthecases.Therewasnodeath,howeveramputationwasperformedin9patients(32.1%).Closedarterialinjuriesareusualycausedbycontusivetraumaandthemecha-nisminvolvedisrathercomolexandandsevereenoughtocauseassociatedlesions.Noexternalheamor-rhage.noropenwoundcouldbeseenandtheclinicalpresentationoftenremainsoccultleadingtodelayindiagnosisandtreatment,andthereforecarryingahighamputationrate.Earlyaccuratediagnosisandpromptsurgicaltreatmentoftheinjuredarteriestorestorecirculationofthelimbwithin12hoursfol-lowingtheinjuryarethecurcialfactorsforasuccessfullimbsalvage.Meticulousmanagementoftheas-sociatedlesionsandafasciotomywhenindicatedalsoareimportantmeasuresforasatisfactoryfunction-alresult.