膝关节脱位合并腘动脉损伤的漏诊及误诊分析

Missed and misdiagnosis of popliteal artery injury associated with knee dislocations

[目的]分析腘动脉漏诊及误诊的原因，尽早诊断，尽早手术，保存肢体，减少病废及病残。[方法]分析本院1998～2003年收治的12例漏诊及误诊的病人，误诊时间8～50h，平均22．6h。栓塞5例，破裂7例。其中多发伤5例。术前介入科血管造影5例，1例病人行血管再通。其余病人均手术探查，端端吻合2例，大隐静脉翻转移植吻合6例。血管探查同时行小腿骨筋膜室综合征切开减压术。3例病人因肢体坏死直接截肢。[结果]3例病人术后完全无肢体缺血挛缩并发症；2例病人遗留不同程度的肢体缺血挛缩表现；4例病人保肢失败，再次手术截肢。[结论]腘动脉损伤漏诊及误诊的原因：（1）对腘动脉的解剖不熟悉；（2）因膝关节搬运过程中自动复位畸形消失而被忽视；（3）合并其它更严重的损伤，抢救生命而忽略腘动脉损伤；（4）没有重视下肢体格检查，漏掉腘动脉损伤体征。

[ Objective] To analyze the reasons of the missed and misdiagnosis of popliteal artery injury associated with knee dislocations, so that the patients can be diagnosed as early as possible. Amputation can be avoided. [ Method ] Twelve patients admitted in our hospital 1998 - 2003 who were misdiagnosed in other hospitals. Five patients had compound injured. The misdiagnosis time was 8 - 50 hours, meaned 22.6 hours. Five patients had an arteriogram after register, one of them was recanalizated in radiology department. Other 6 patients were operated with saphenous vein bypass grafting,2 patients were anastomosed the end to the end and 3 patients were amputated directly. [ Result] Three patients were healed completely, 2 patients remained ischemic symptoms, 4 patients were operated again with amputation. [ Conclusion] There are four reasons for the missed and misdiagnosis： a. The doctors were not familiar with the anatomy of the popliteal artery; b. The knee was automatically reduction in the process of transmitting. There was no deformity when arriving at the hospital;c. The patients were severely injuried and the knee dislocations was ignored, d. The physical examination was not carefully done.