胫骨近端骨折合并腘血管损伤的诊断和治疗

Diagnosis and Treatment of Proximal Tibial Fracture with Popliteal Vascular Injury

目的：总结胫骨近端骨折合并腘血管损伤的诊断治疗经验。方法：2009年5月-2013年5月期间,我科共收治7例胫骨近端骨折合并腘血管损伤患者,从受伤至血管造影确诊时间为伤后6~25h,平均10.3h,探查见腘动、静脉完全及不完全断裂各3例,腘动、静脉挫伤并栓塞1例,所有病例在确诊后立即手术,行胫骨近端骨折外固定架跨膝关节固定＋腘血管探查吻合移植修复治疗。结果：其中6例下肢存有不同程度功能障碍及畸形,1例行截肢术。结论：胫骨近端骨折合并腘血管损伤后,应仔细检查,尽早行血管造影,避免漏诊,明确诊断后应尽快固定骨折,探查吻合血管,最大程度避免截肢等不良后果。

Objective： To sum up the diagnosis and treatment experience of proximal tibial fractures combined with poplite- al vascular injury. Methods： From May 2009 to May 2013, 7 cases of proximal tibial fractures combined with popliteal vascular injury were treated in our department. The time from angiography to diagnosis was 6-25 hours after injury, aver- aged 10.3 hours. 3 cases for complete and incomplete rupure respectively; Popliteal artery and vein contusion with throm- bosis in 1 case. Proximal tibial fracture external fixation and popliteal vessel anastomosis graft restorative treatment were performed immediately after diagnosis in all cases. Results： Varying degrees of lower limb dysfunction and deformity were found in 6 cases and amputation surgery for 1 case. Conclusion： Carefully check and earlier angiography should be done after proximal tibial fractures with popliteal vascular injury to avoid missed diagnosis. Fracture fixation and popliteal ves- sel anastomosis should be done as soon as possible after the diagnosis, so as to avoid amputation and other adverse consequences.