闭合性腘动脉损伤的诊治

Diagnosis and treatment of closed popliteal artery injury

目的探讨闭合性胭动脉损伤的诊治方法和效果。方法13例闭合性胭动脉损伤患者，10例采取动-静脉吻合和桥接术治疗，2例因肌肉缺血坏死行一期截肢术，1例行保守治疗。结果动-静脉吻合和桥接术10例中血管再通肢体成活9例。血循环重建时间3．5～35h，其中8h以内重建血循环8例，肢体功能恢复良好，1例遗留不同程度的缺血性挛缩，另1例术后26h再次栓塞，保守治疗无效而行二期截肢。保守溶栓治疗成功1例。13例中3例截肢。病残病废共5例，其中1例腓总神经损伤肢体功能部分恢复。结论闭合性胭动脉损伤应尽早明确诊断，在8h内修复者效果好，超过这一时限病残率及截肢率均明显上升。

Objective To investigate the diagnosis and treatment of closed popliteal artery injury, and to study the effect. Methods 13 cases with closed popliteal artery injuries were enrolled, in which 10 were treated with arteriovenous anasmtomosis and bridging, 2 with primary amputation due to muscular ischemic necrosis, and 1 with conservative way. Results Of the 10 cases undergone arteriovenous anasmtomosis and bridging, 9 limbs survived. Vascular reconstruction was done in 3.5 - 35 hours, of which 8 cases were done in 8 hours and the limbs function recovered well; 1 remained ischemic muscular contracture; 1 got re-embelization and received amputation; 1 got successful thrombelytic therapy. 3 got amputation in 13 cases. 5 got disabilities, of which 1 with common fibular nerve injury got partial recovery. Conclusions Closed popliteal artery injury should be diagnosed early and treated in 8 hours, and the disability and amputation rates are significant increased when treated latterly.