外固定架在四肢骨干骨折并血管损伤中的应用

The application of external fixator in limbs backbone fractures accompanied vascular injury

目的介绍外固定架结合显微外科技术治疗合并血管损伤的四肢骨干骨折的方法和疗效。方法对17例合并血管损伤的四肢骨干骨折患者应用多功能外固定架结合显微外科技术治疗。其中,肱骨骨折并肱动脉损伤3例,股骨骨折并股(腘)动脉损伤5例,胫腓骨骨折合并腘(胫前、后)动脉损伤9例。开放性损伤13例,闭合性损伤4例。休克患者3例。直接吻合6例,取静脉进行血管移植11例。结果术后随访11～19个月,平均14个月。术后除1例最终截肢外,其余肢体全部成活。1例患者发生大出血,术中探查为其他血管断端出血,行结扎处理。10例患者在减张口内见肌肉组织坏死。1例患者发生急性肾功能衰竭,经过透析治疗,各项指标恢复正常,肢体得以保留,但肌肉组织发生坏死,患肢功能较差。本组未发生足下垂。5～9个月16例骨折均愈合。结论外固定架具有操作简单、时间短、创伤小、固定可靠等优点,非常适用于四肢骨折并血管损伤。

Objective To introduce the treatment method and efficacy of limbs backbone fractures accompanied vascular injury with external fixator combined microsurgical technique. Methods The multifunctional external fixator combined microsurgical technique treated 17 patients with limbs backbone fractures accompanied vascular injury.Which humeral fractures and brachial artery injury in 3 cases,femoral fractures and shares （popliteal） artery injury in 5 cases, tibia and fibula fracture with popliteal （anterior tibial, posterior tibial） arterial injury in 9 cases.13 cases of open injury, 4 cases of closed injury.Three cases of patients with shock.Direct anastomosis of the six cases,the venous vascular graft in 11 cases. Results The postoperative follow-up of 11 to 19 months,an average of 14 months.After surgery,apart from one case ultimately amputation,the remaining limb survived.One patient bleeding,intraoperative exploration for other vascular stump bleeding,did ligation processing.The wound to reduce tension existed muscle tissue necrosis in 10 patients.1 patient developed acute renal failure,after dialysis treatment,the indicators back to normal,the limb was preserved,but the muscle tissue necrosis,poor limb function.The group did not occur foot drop.16 fractures healed after 5 to 9 months. Conclusion External fixator has the advantages of simple operation,short time of surgery,trauma,reliable fixation,very suitable for limb fractures and vascular injury.