闭合性膝关节周围骨折合并腘动脉损伤的手术治疗

Operation treatment of popliteal artery injury associated with closed fracture around the knee

[目的]回顾性分析一期单边外固定架固定骨折,二期更换内固定治疗闭合性膝关节周围骨折合并腘动脉损伤的临床疗效。[方法]自2007年3月~2009年6月,共收治闭合性膝关节周围骨折合并腘动脉损伤患者5例,通过临床检查、血管Doppler检查,及早明确诊断,手术探查明确腘动脉损伤后一期采用单边外固定支架跨膝关节固定骨折,及时修复损伤的动脉,预防性小腿骨筋膜室切开减压,术后抗凝、解痉、抗感染治疗,二期更换外固定支架为内固定,术后早期功能锻炼,并随访其疗效。[结果]5例患者均采用该方法,从开始手术至血管再通58~100min,平均70.6 min,术后随访1~2年（平均15.6个月）。所有患者受伤肢体均存活,无肌肉软组织坏死,手术切口及减张切口无感染发生,骨折骨性愈合,术后膝关节功能Lysholm评分76~88分,平均83.6分。[结论]一期单边外固定架跨膝关节固定同时吻合腘动脉,二期更换内固定,早期功能锻炼是临床治疗闭合性膝关节周围骨折合并腘动脉损伤的有效方法。

[Objective]To analyze operation treatment of popliteal artery injury associated with closed fracture around the knee.[Method]Five patients（M=5） with popliteal artery injury associated with closed fracture around the knee were managed from March 2007 to June 2009.All patients underwent operation（external fixation of single arm external fixator in the very early stage,arterial repair,venous repair-ligation,anticoagulation-thrombolytic therapy,fasciotomy）.Then it was replaced by strong internal fixation through open reduction and early postoperative exercises.[Result]The patients were all followed up for 15.6 months（range,24-48 months）.The vascular repair was performed with an average time of 70.6min（range,58-100 min）.All the operative wounds healed and all bone fractures united.Excellent results for the knee joint function was 100%.[Conclusion]It is an effentive way to treat popliteal artery injury associated with closed fracture around the knee by external fixation of single arm external fixator in the very early stage,with arterial repair,venous repair-ligation,anticoagulation-thrombolytic therapy and fasciotomy）,and then replaced by strong internal fixation through open reduction and early postoperative exercises.