外固定架在膝及小腿血管损伤修复中的应用

Application of external fixator in vascular injuries to the knee and calf

目的探讨外固定架在膝、小腿血管损伤中的应用效果。方法回顾性分析2004年5月至2010年10月应用外固定架治疗的208例（234侧）膝及小腿血管损伤患者资料，男192例（217侧），女16例（17侧）；年龄14-67岁，平均39．6岁。损伤血管：胭动脉84例（86侧），胫前动脉36例（46侧），胫后动脉41例（49侧），胫前后动脉47例（53侧）。伤肢远端完全缺血129例（141侧），不完全缺血79例（93侧）。所有患者均行急诊手术。采用AO通用外固定架164例，创生镶嵌式外固定架37例，组合式外固定器7例。血管采用直接或大隐静脉桥接吻合。创面采用一期包扎、植皮、皮瓣移植和VSD负压吸引治疗。结果194例保肢成功，14例因伤肢毁损严重及全身情况差于术后2-4d截肢。术后43例患者创面自行愈合，127例二期行手术清创植皮或皮瓣治疗，24例一期行游离皮片或皮瓣移植覆盖。148例获得8个月-3年的完整随访，其中6例因患肢功能严重受限且伴发骨髓炎而自愿要求截肢。拆除外固定架时间1-18个月，平均7．2个月。102例骨折获得愈合，时间为3-13个月，平均5．6个月；40例出现骨折不愈合、骨缺损，行骨折内固定＋植骨术或骨段滑移术，骨折均愈合。结论外固定架具有固定可靠，可在短时间内复位骨折，减少肢体缺血时间等优点，利于膝、小腿血管损伤的修复。

Objective To investigate the effect of external fixator on repairing the vascular injuries in the knee and calf. Methods From May 2004 to October 2010, 208 patients （234 sides） with vascular in- juries in knee and calf, treated with external fixation, were retrospectively analyzed, including 192 males （217 sides） and 16 females （17 sides） with an average age of 39.6 years （range, 14-67）. Blood vessel damage： the popliteal artery injury in 84 patients （86 sides）, the anterior tibial artery injury in 36 （46）, the posterior tibial artery injury in 41（49）, the anterior tibial artery and the posterior tibial artery injury in 47 （53）. Com- plete ischemic of the injured distal limb existed in 129 patients（141 sides）, incomplete ischemia in 79 patiets （93 sides）. All patients underwent emergency surgery. The AO external fixators were used in 164 patients, the chuangsheng inlaid external fixators in 37, and the hybrid external fixators in 7. The injured vessels were anastomosed directly, or indirectly with great saphenous vein. The wounds were treated with phase I bandage, skin grafts, flap transplantation or VSD suction. Results One hundred and ninty four patients obtained suc- cessful limb salvage; but 14 patients underwent amputation owing to serious damage of limb and poor general condition. One hundred and twenty seven patients underwent the second stage debridement combined with skin graft or flap transplantation; 24 patients underwent the first stage free skin graft or flap transplantation; wound cicatrized by oneself in 43 patients. One hundred and forty eight patients were followed up for 8 months to 3 years. External fixators were removed after an average of 7.2 months （range, 1-18）. The average healing time of fracture in 102 patients was 5.6 months （range, 3-13）. Forty patients suffered bone nonunion or bone defect; after treated by fracture fixation, bone graft or bone transport, all of them got bone union. Conclusion The external fixation can shorten operation time as well as the time of limb ischemia, which is an effective option on repairing vascular injuries in knee and calf.