四肢主要动脉钝性损伤的伤情特点分析

Clinical features of blunt major arterial injury in the extremity

目的总结四肢主要动脉钝性损伤的伤情特点,为制订有针对性的诊治方案提供依据。方法回顾性分析中山大学附属第一医院1998年1月至2009年6月收治的四肢主要动脉钝性损伤患者的病历资料,并以同期收治的锐性损伤患者作对照,分析四肢主要动脉钝性损伤的伤情特点。结果本组共61例四肢主要动脉钝性损伤患者,道路交通伤和重物压砸伤者占91.80%,下肢损伤占73.77%;53例动脉锐性损伤中由切割伤所致占92.45%,上肢损伤占79.25%。钝性损伤患者在合并骨折的比例、血管移植的比例、住院手术次数及截肢率均高于锐性损伤组(P<0.05),住院时间也长于锐性损伤组(P<0.05)。结论与动脉锐性损伤比较,四肢主要动脉钝性损伤多由高能量损伤引起,下肢多见,绝大多数合并骨折和严重的软组织损伤,伤情复杂,处理困难,并发症发生率和截肢率均较高。

Objective To summarize the clinical features of blunt major arterial injury in the extremity so as to provide the basic evidences for developing specific management strategy. Methods The patients having major arterial injury in the extremity admitted to the First Affiliated Hospital of Sun Yat-sen University from January 1998 to June 2009 were included in this study. Based on the mechanism of injury, they were divided into blunt injury group （BIG） and penetrating injury group （PIG）. The charts were re- viewed and the information regarding demographics, clinical course and early outcomes were collected and analyzed. Results There were 61 cases in BIG. The mechanism of injury was dominant at road traffic injury and crush injury （91.80%）. The lower limb injury accounted for 73.77%. Fifty-three cases in PIG were mainly injured by cut （92.45%） and the most common injury site was the upper limb （79.25%）. The pro- portion of combined fracture, the proportion of vascular grafting, operation times and amputiation rate in BIG were higher than those in PIG （ P 〈 0.05 ）. The length of stay in BIG was longer than that in PIG （ P 〈 0.05）. Conclusions Compared to PIG, blunt major arterial injury in the extremity is usually caused by high energy injuries and the lower limb is often involved. It is often associated with long bone fracture and severe soft tissue injury. Such injury is characterized by complex local and general conditions and challenge in management, with high risk of comphcation and amputation.