膝关节周围骨折、脱位伴血管损伤的诊疗分析

The treatment of knee joint peripheral fractures and/or dislocations with vascular injury

目的探讨早期诊治膝关节周围骨折损伤的效果及影响因素。方法回顾性分析2002年3月至2007年11月31例膝关节周围骨折、脱位伴血管损伤患者的临床资料。其中男性24例，女性7例，年龄21～62岁，平均41岁。结合临床体征，运用彩色超声、CTA、手术探查等明确血管损伤，分别采用外固定支架、钢板、螺钉固定骨折脱位，并根据具体情况对损伤血管进行取栓、修补、自体静脉或人造血管移植重建血循环，分析保肢指数（predictive salvage index，PSI评分）、早期诊断、治疗方法对预后的作用。结果本组病例1例死亡，截肢6例，手术成功修复31例股动脉、胭动脉、胫前及胫后动脉，24例肢体存活患者分别随访1～4年，平均24．2个月。6例骨不连或感染骨缺损经二期植骨、骨转运骨折愈合，7例膝关节脱位患者进行二期韧带修复重建，功能优良率为71．4％。结论PSI评分≤10分的膝关节周围骨折、脱位伴血管损伤患者应积极实施治疗，早期明确诊断、手术重建血循环是治疗成功的关键因素。

Objective To investigate the effect and infulence factors on knee joint peripheral fractures and/or dislocations with an associated vascular injury through retrospectively study. Methods From March 2002 to November 2007 31 patients with knee joint peripheral fractures and/or dislocations with an associated vascular injury were treated, including 24 males and 7 females with a mean age of 41 years（ range from 21 to 62 years ） . Definituding diagosis of vascular injury by combining colored ultrasonic, CTA, operative exploration with clinical signs, fixing fractures and/or dislocations with fixators, plates and screws, reconstructing blood circulation based on the condition of the vascular injury by vascular repair, homograft vein or artifical vascluars grafting separately and analysising the effects of PSI, diagnosis and treatment methods on salvage lower extremities. Results Successful reconstruction was carried out in 31 cases, however there were 1 death because of mult-fractures and brain injury and 6 amputation, 24 cases successful salvage followed up mean 24. 2 months, 6 cases bone nonunion and infected bone defect were cured by delayed bone planting or bone transportation. Ligaments repair reconstruction of 7 cases knee joint dislocation were done in delayed 3 or 4 weeks after first operation, the good functional rate was 71.4%. Conclusions The patients of PSI under 10 grades in knee joint peripheral fractures and/or dislocations with an associated vascular injury should been carried out treatment, early definited diagnosis and blood circulation reconstruction are the key factors of successful salvage treatment.