四肢主干血管损伤的诊治

DIAGNOSIS AND TREATMENT OF VASCULAR INJURY IN LIMBS

目的探讨四肢主干血管损伤的早期诊断、治疗方法以及临床效果。方法2001年1月-2006年6月,收治72例四肢主干血管损伤患者。男50例,女22例;年龄5～60岁,中位年龄39岁。开放性损伤44例,闭合性损伤28例。动脉损伤部位:锁骨下动脉1例,股动脉23例,腘动脉20例,尺桡动脉同时损伤12例,肱动脉11例,腋动脉3例,胫前后动脉同时损伤2例。伤后至入院时间30 min～27d。术中血管破口直接修补3例,端端吻合39例,自体大隐静脉移植修复30例,移植长度3～8cm。结果67例肢体成活,5例截肢。48例获6个月～5年随访,彩色多普勒血流仪检查血流速度及血管口径与健侧无明显差异。40例肢体功能恢复满意,8例残留不同程度功能障碍,其中4例行矫形或功能重建手术,功能及外形得到改善。结论了解损伤机制及受伤情况,认真体检,综合分析,是主干血管损伤早期诊断的关键;显微外科修复是提高血管通畅率的保障;术后筋膜间室综合征及肢体缺血时间超过4h的肱动脉、腘动脉以上的血管损伤,及时行筋膜间室切开是恢复肢体功能、避免伤残的有效手段。

Objective To report the diagnosis methods and clinical treatment effects of blood vessel trunk damage in limbs. Methods From January 2001 to June 2006, 72 patients with vascular injury in limbs were treated. There were 50 males and 22 females, aged from 5-60 years （median 39 years） and including 44 cases of open injury and 28 cases of closed injury. The locations were subclavian artery in 1, femoral artery in 23, popliteal artery in 20, radia artery and ulna artery in 12, brachial artery in 11, axilary artery in 3 and anterior and posterior tibia artery in 2. The disease course was 30 minutes to 27 days. Injured arteries were repaired by suturing directly in 3 cases, by end-end anastomosis in 39 cases and by saphenous transplantation in 30 cases. The length of transplant veins was 3 cm to 8 cm. Results In 72 cases, 67 survived and 5 were given amputation. Fortyeight cases were followed up 6 months to 5 years. The blood flow rate and the diameter of blood vessel on the affected limbs were not different from that of normal limbs by colorful Doppler blood flow monitor. Forty cases recovered satisfactory limb function. Eight cases had different degrees of dysfunction, of them, four cases received functional reconstructive operation, and the function and appearance were improved. Conclusion To investigate the mechanism and situation of injury, to examine patients carefully and analyze comprehensively are the key points of making earlier diagnosis for branch blood vessel damage; microsurgical repair of the injured blood vessel is the assurance of the blood flow rate. For the blood vessel above elbow and knee injured and lacked blood supply more than 4 hours and fascia syndrome, earlier opening the fascia cavity is the effective methods to recover the function of the limbs and to avoid disability.