血管闭塞所致下肢坏疽截肢术

Amputation of lower limb necrosis caused by vascular occlusion

目的探讨既能尽量截除因血管闭塞而坏疽的肢体,又可使残肢与假肢达到最佳适配的方法。方法2003年6月至2007年2月期间共收治血管闭塞症所致下肢坏疽患者21例(23肢),参考血管多谱勒和CT血管造影检查结果,结合患肢坏死平面或皮肤颜色、温度、软组纫血供状况选择截肢部位,截肢部位为股骨上端2例(3肢)、股骨中下1／3端5例、胫骨中端和中上1/3端14例(15肢)。结果21例残肢伤口均愈合良好,1例因双残端软组织挛缩致骨外露行残肢修整术,术后14天伤口愈合。结论截肢部位选择不当既可能引起残端再度坏死、伤口不愈合及骨外露,增加患者再次手术的风险和痛苦,也可能导致过多截除有用肢体和关节,影响日后假肢的正常安装和使用。血管闭塞所致下肢坏疽截肢术不仅要为患者保留存活的残肢,更要保留有功能的残肢。

Objective To find the way to amputate necrotic limbs caused by vascular occlusion as completely as possible while the deficient limbs could also satisfy the artifieal limb installation. Methods From Jun. 2003 to Feb. 2007, 21 patients （23 limbs） with lower limb necrosis caused by vascular occlusion were treated in our hospital. We chose the amputation position by analysing the DPR and CTA results, also investigating the deficient limb＇s necrotic plane surface, skin color, temperature and the situation of the soft tissues blood supply. The amputation position of 2 cases（3 limbs） is at the upper of femur, 5 cases at 1/3 mid bottom of femur, 14 cases（ 15 limbs） at the middle and 1/3 mid-upper of tibia. Results All 21 cases healed very well. One case had a repairing operation due to the bone revealing caused by the soft tissue contracture, the cut healed 14 days after the operation. Conclusions In brief, inappropriate amputation position could probably lead to a repeated necrosis, no cut healing or bone revealing, increasing the risk of a second operation and more suffer to the patients, it could also result in excess of amputation on the useful limbs and affecting the installation and regular use of the artificial limbs. The amputation is not only to retain an alive deficient limb, but also a functional one.