膝关节周围骨折脱位合并腘动脉损伤诊治体会

Diagnosis and treatment of popliteal artery injury associated with fractures and dislocations around the knee

目的探讨膝关节周围骨折脱位合并腘动脉损伤的诊断与治疗效果。方法 16例膝关节周围骨折脱位合并腘动脉损伤患者中,行腘动脉端端吻合4例,自体大隐静脉或小隐静脉移植12例;同时修复腘静脉9例,胫神经吻合6例,腓总神经吻合2例。结果肢体血循环重建时间4.5～26.5h,9例痊愈后肢体血循环恢复良好,3例遗留小腿缺血性肌挛缩,4例截肢。11例获得随访,时间12～18个月。术后1年时膝关节功能评定参照美国特种外科医院(HSS)膝关节评分标准:优5例,良2例,中1例,差3例。结论膝关节周围骨折脱位合并腘动脉损伤早期诊断是挽救肢体的关键,尽早恢复肢体血循环、高质量修复损伤血管、有效复位固定骨折是降低致残率和促进肢体功能恢复的重要因素。

Objective To study the principle of diagnosis and treatment for patients with fractures and dislocations around the knee associated with popliteal artery injury.Methods Sixteen patients with fractures dislocations around the knee associated with popliteal artery injury were treated.4 patients were treated with direct vasostomy,and other 12 were repaired with autotransplantation of great saphenous vein or small saphenous vein.On the mean time,nine patients associated with popliteal vein injury were repaired,6 cases associated with tibial nerve injury and 2 cases associated with common peroneal nerve injury were anastomosed respectively.Results It took 4.5-26.5 hours to reestablish the circulation of limbs averagely.9 cases were reestablished the circulation of limbs successfully,3 cases remained muscle contracture of leg caused by ischemia and 4 cases were amputated.11 cases were followed up for 12-18 months and articular genu function were evaluated according to HSS standards：5cases were excellent,2 good,1 fair and 3 poor.Conclusions The earlier diagnosis and treatment for fractures dislocation around the knee associated with popliteal artery injury are very important for improving prognosis.There are other considerable methods,such as immediate reestablishment of the circulation of limbs,high quality of vascular anastomosis and proper fracture reposition and fixation.