浮膝损伤合并血管损伤的处理

Treatment of Floating Knee Injury Complicated with Blood Vessel Injury

目的探讨浮膝损伤合并血管损伤患者的手术方法及临床疗效。方法浮膝损伤伴血管损伤19例,骨折复位固定同时行血管损伤大隐静脉移植修复术11例,人工血管修复3例,直接行端端吻合术3例,单纯修补术2例。对8例小腿严重创伤合并筋膜间室综合征者行小腿筋膜切开减压术,伤后3月修复交叉韧带损伤2例。结果1例患者合并严重挤压综合征死亡,2例在伤后48 h探查吻合血管患者二期截肢,肢体存活16例,此16例获随访0.5-2年。根据Karlstrm评价标准优6例,良7例,中2例,差1例,优良率为81.25%。人工血管修复的3例术后血流通畅。13例基本恢复正常生活和工作;2例足部感觉正常,肌力3级,生活基本自理;1例长期昏迷,生活不能自理。结论对于合并血管损伤的浮膝损伤,应尽早诊断及重建血液循环,防止严重并发症的产生,尽可能恢复患者功能。

Objective To discuss the surgical techniques and clinical outcomes for the treatment of floating knee injury complicated with blood vessel injury.Methods From June 2002 to June 2008,19 cases of floating knee injury complicated with blood vessel injury were admitted in our institution.Reconstruction of blood vessel injury was performed at the same time as fractures were replaced and fixed.11 blood vessel injuries were repaired by great saphenous venous grafts,3 by vascular prosthesis,2 by end-to-end anastomosis and the other 2 simply by neoplasty.Open decompression was performed in 8 cases with osteofascial compartment syndrome and cruciate ligaments were repaired in 2 cases.Results One patient died because of severe osteofascial compartment syndrome.Two cases that had blood vessel exploration and repair 48 hours after injury finally had their lower extremities amputated later.There were all together 16 cases had their lower extremities successfully reserved.Of these 16 cases,when the clinical outcomes were accessed according to the Karlstrm＇s evaluation criterion after 0.5 to 2 years of follow-up,6 were excellent,7 were good,2 were fair and 1 was poor.In all,81.25% patients had excellent or good results and could basically live and work normally;2 had normal sensation in the feet and grade Ⅲ muscle strength;one was stayed unconscious.Conclusions For floating knee injury complicated with blood vessel injury,early diagnosis and early repair of blood flow is of vital importance.Moreover,severe complications should be closely observed and prevented,and good functional recovery should be attempted whenever possible.