膝部超时限腘动脉损伤的治疗

TREATMENT OF DELAYED POPLITEAL ARTERY TRAUMA OF KNEES

目的总结超时限腘动脉损伤的诊治经验和教训。方法1995年2月～2006年1月,收治28例腘动脉损伤时间超过8h的患者。其中男25例,女3例;年龄3～53岁。车祸伤12例,高处坠落伤3例,火器伤2例,锐器伤3例,绞扎伤2例,其他6例。20例未扪及动脉搏动,8例动脉搏动减弱。2例见裸露腘动脉和/或活动性喷血,8例直接手术探查,18例彩色多普勒检查示腘动脉及分支有彩色血流信号通过。7例腘动脉缺损<5cm,9例缺损>5cm。损伤至血管再通时间8～150h,平均31.8h。采用端端吻合、大隐静脉移植修复16例,截肢12例。结果行动-静脉吻合或桥接术的16例患者,15例血管再通,肢体存活,其中12例1年内下肢功能基本恢复,3例遗留不同程度足下垂和踝关节挛缩,另1例枪伤患者因吻合血管术后1d再次栓塞,行二期截肢;血管吻合术后肢体存活率94%(15/16)。28例患者均获随访6个月～11年,平均4.2年。无死亡患者,截肢率43%,病残率54%。结论腘动脉损伤的预后主要取决于血管再通时间和侧支循环的血氧代偿能力;延误诊断和治疗是严重腘动脉损伤截肢率居高不下的主要原因。

Objective To summarize the experience in treatment and diagnosis of popliteal artery trauma and to determine the factors for amputation. Methods From February 1995 to January 2006, 28 patients with popliteal artery trauma were treated. The disease course was more than 8 hours. Of them, there were 25 males and 3 females, aging from 3 to 53 years. Trauma was caused by traffic accident in 12 cases, by falling from height in 3 cases, by fire- arm in 2 cases, by sharp instruments in 3 cases, by strangulation in 2 cases and by others in 6 cases. No arteriopalmus or weak arteriopalmus were observed in 18 cases and in 8 cases respectively. Popliteal artery exposure or active bleeding was seen in 2 cases; the popliteal arteries were examined by operation in 8 cases; color ultrasound Doppler flow imaging showed color flood flow signals were through popliteal artery and its branches in 20 cases. Defect size of popliteal artery was less than 5 cm in 7 cases and more than 5 cm in 9 cases. End to end anastomosis reconstruction by saphenous vein graft and direct suture was performed in 16 cases and ampulation in 12 cases. The time of the revascularization of the leg was 8-150 hours （mean 31.8 hours）. Results All patients were followed up 6 months to 11 years with an average of 4.2 years. In 16 cases given end to end anastomosis reconstruction, 15 cases achieved revascularization and limb survival; lower limb function restored to normal within 1 year in 12 cases; foot drop and ankle joint contracture occurred in 3 cases and the survival rate of limbs was 94%. Amputation was given in 12 of 28 cases because of severe trauma. The rate of amputation was 43% and the rate of disability was 54%. Conclusion Popliteal artery trauma should be treated as soon as the diagnosis is made. If the revascularization is more than 8 hours or circulatory compensation is not complete, it will affect the leg survival. Delayed diagnosis and severe traumas are the cause of high rate of amputation in popliteal artery trauma.