膝部骨折合并腘动脉损伤23例临床分析

Fractures around the Knee with Injury to PoplitealArtery:a Retrospective Analysis of 23 Cases

目的:回顾性分析膝部骨折合并腘动脉损伤的治疗方法和效果。方法:23例膝部骨折合并腘动脉损伤的患者,其中肢体严重缺血患者(远端动脉搏动消失,皮温下降,皮肤花斑或者苍白)13例,部分缺血患者(远端动脉搏动减弱,或者消失但有毛细血管充盈征)10例。腘动脉修复方法:端端吻合术4例,修补术5例,切开取栓术3例,对侧大隐静脉移植修复术10例。修复顺序:先修复血管再固定骨折8例,先固定骨折再修复血管14例,处理骨折前先建立临时性动脉内分流10例。结果:肢体存活19例,截肢4例。截肢者均为严重缺血患者,其中1例患者因严重骨折和广泛软组织损伤合并急性肾功能衰竭行I期截肢,3例患者因术后反复感染(1例合并肾功能不全)行Ⅱ期截肢。严重缺血的患者只有3/13例完全恢复,而部分缺血的患者有6/10例完全恢复。血管再通时间≥8h的患者只有4/13例完全恢复,而血管再通时间<8h的患者有5/9完全恢复。结论:膝部骨折合并腘动脉损伤时,肢体缺血程度和缺血时间是影响患者康复的重要因素,术后感染仍是造成截肢的主要原因。

Objective： To evaluate the treatment and curative effect of patients who had combination ofpopliteal artery injury and fractures around the knee. Method： Among the 23 cases of fractures around the knee conbined with popliteal artery injury, 13 had severe ischemia with absent distal pulses and mottled, cold skin in leg, and 10 patients had partial ischemia with absent pulses but with some capillary refill or only diminished pulses in feet. The restorative methods were as follow： 4 cases by primary sutur, 5 by primary repair, 10 by venous grafting, 3 by thrombectomy. In the group, the vascular repair was taken the priority in 8 patients, fixation was the priority in 14 patients, and temporary intraluminal shunts was used in 10 patients. Results： The limbs were salvaged in 19 patients. Amputations were performed in 4 patients who had severe ischemia （one primary amputation, three secondary amputations）. In group of severe ischemia, only 3 of 13 patients recovered completely, in comparison with 6 of 10 patients with relative ischemia. In group of revasculariza- tion after 8 hours, only 4 of 13 patients recovered completely, in comparison with 5 of 9 patients with revascularization within 8 hours. Conclusion： In popliteal artery injury with fractures around the knee, the degrees ofischemia and duration ofischemia affect the recovery of patients.Infection is still the major reason of secondary amputmion.