膝部骨折脱位合并腘动脉损伤21例

Dislocation or fractures around the knee with popliteal artery injury:a retrospective analysis of 21 cases

[目的]回顾性分析膝部骨折脱位合并腘动脉损伤的治疗方法和效果。[方法]本组21例，男17例，女4例；年龄16—68岁，平均34．3岁。骨折脱位情况：膝关节脱位2例，股骨下端骨折4例，胫骨上端骨折9例，浮膝6例。动脉修复方法：端端吻合7例，大隐静脉移植14例。骨折及脱位固定方法：石膏固定2例，内固定14例，外固定架固定5例。修复顺序：2例膝关节脱位合并腘动脉损伤的患者先手法复位膝关节再修复血管，膝部骨折合并腘动脉损伤的患者先修复血管，后固定骨折6例，先固定骨折再修复血管5例，在处理骨折前先建立临时性动脉内分流8例。[结果]所有患者均获随访，随访时间1—7年，平均3．3年。肢体存活17例（81％），截肢4例。截肢者均为入院时肢体严重缺血患者，部分缺血患者无1例截肢；截肢患者中有3例合并严重软组织损伤，1例合并中度软组织损伤；肢体存活患者平均MESS评分4．2±1．3，截肢患者平均7．2±1．8。截肢患者均是由于术后出现难以控制的感染而截肢。[结论]膝部骨折脱位合并腘动脉损伤时，肢体的软组织损伤程度、MESS评分、肢体缺血的严重程度均是影响肢体成活的重要因素，术后感染是造成截肢的主要原因。

[ Objective] To evaluate the treatment of a subset of patients who had a combination of popliteal artery injury and dislocation or fractures around the knee. [ Method ] Twenty-one eases were involved. Of these, 17 were males and 4 were females; the mean age was 34.3 years. These traumas involved 2 knee dislocations and 19 fractures. Of these fractures,4 involved distal femur,9 proximal tibia and 6 a floating knee. Seven eases of arterial injuries were managed by end-to-end anastomosis, 14 by great saphenous vein interposition graft. Dislocation was fixed with plaster east in 2 patients,fracture fixed with internal fixation in 14 patients, and external fixation in 5 patients. In the two patients of knee dislocation with popliteal artery injuries, closed reduction was prior to vascular repair. In the group of a combination of popliteal artery injury and fractures： the vascular repair was taken the priority in 6 patients ,fixation was the priority in 5 patients ,and with the use of temporary intraluminal shunts in 8 patients. [ Resnlt] All patients were available for an average follow-up of 3.3 years（ ranged, 1 - 7years）. The limbs were salvaged in 17 patients （81% ）. Amputations were needed in 4 patients. All had severe isehemia, and 3 had major soft tissue injury. The average MESS of salvaged limbs was 4.2 ± 1.3, and MESS of those limbs that required amputation was 7.2 ± 1.8. Amputation was required owing to a combination of overwhelming gangrene and sepsis. [ Conclusion] For eases of popliteal artery injury ,with dislocation or fractures around the knee, the prognosis is worse related to severity of soft tissue injury, the level of isehemia and higher MESS score. Infection is the major reason of secondary amputation.