纵向生物力学特性对动脉损伤修复方法选择的影响

LONGITUDINAL BIOMECHANICAL EFFECT ON REPAIR OPTIONS OF ARTERY INJURY

目的 研究人体四肢主要动脉不同长度损伤与修复方法选择之间的关系 ,比较由于血管纵向生物力学特性而产生的修复差异 ,为临床修复效果及近、远期疗效评价提供依据。方法 回顾分析应用端端吻合法和自体静脉移植法修复的四肢主要动脉伤共 177例 185条血管。对相同损伤部位而不同修复方法的血管的真性缺损长度做 t检验比较 ,通过 95 %置信区间分析两种修复方法的选取界限。对自体静脉移植修复血管中真性缺损长度与移植长度做线性相关与线性回归分析。结果 端端吻合与自体静脉移植修复肱动、股动脉、月国动脉真性缺损长度间存在非常显著性差异 (P<0 .0 1)。端端吻合修复肱动脉真性缺损长度 95 %置信区间上限为 3.17cm,股动脉为2 .81cm,月国动脉为 2 .44 cm。静脉移植修复肱动脉真性缺损长度 95 %置信区间下限为 2 .82 cm,股动脉为 2 .41cm,月国动脉为 2 .17cm。静脉移植修复肱动脉、股动脉、月国动脉真性缺损长度与移植长度间存在线性相关。结论 修复四肢不同部位动、静脉损伤时 ,应考虑其相应血管的纵向生物力学特性影响 ,选择适合的修复方法。

Objective\ To investigate the relationship between the different defect length of vessels and the options of vascular repair, and to compare the different options of repair because of the longitudinal biomechanical effect. Methods\ A clinical analysis was undertaken to evaluate the major arterial and venous injuries in human extremities repaired by end to end anastomoses or venous autograft(177 cases, 185 vessels). Compared the defect length of the same kind of vessels repaired by different options (Student t test). Evaluated the defect length to repair arterial injuries between by end to end anastomoses and by vein graft by means of 95% confidence interval.Results\ There was significant difference between the defect length of brachial artery repaired by end to end anastomosis and femoral artery and popliteal artery repaired by autogenous vein graft (P<0.01). The upper limit of confidence interval in the defect length of brachial artery, femoral artery and popliteal artery was 3.17 cm, 2.81 cm and 2.44 cm respectively by end to end anastomosis by means of 95% confidence interval. The lower limit of confidence interval in the defect length of brachial artery, femoral artery and popliteal artery was 2.82 cm, 2.41 cm and 2.17 cm respectively by vein graft by means of 95% confidence interval. The defect length of brachial artery, femoral artery and popliteal artery repaired by vein graft was linear correlation with the length of graft.Conclusion\ Because of the longitudinal biomechanical difference of arteries and veins in human extremities, different options of repair are necessary to different arterial injuries.