膝关节周围骨折伴腘动脉损伤救治的临床研究

Clinical research and treament of fractures around knee complicated with injury of popliteal artery

目的观察膝关节周围骨折伴腘动脉损伤的保肢治疗过程及功能恢复情况,探讨保肢手术的治疗方案。方法对27例膝关节周围骨折伴腘动脉损伤患者,急诊行骨折固定、腘动、静脉探查修复术,2例行大腿下段1例行膝关节水平截肢术,其余患者的肢体经3-5次（平均4次）手术治疗,肢体得以保留。3例患者的肢体软组织缺损经行背阔肌皮瓣游离移植,其余患者的软组织缺损经行腓肠肌内侧头肌皮瓣或局部直接随意筋膜皮瓣转移修复。术后随访12-24（16±2.39）个月。参照Puno等的标准对康复后肢体功能进行评定。结果患者无死亡,3例患者行患肢截肢,24例患者肢体得以保留,其中4例患者存在明显的足下垂、垂趾等畸形,功能评定为差。结论膝关节周围骨折伴腘动脉损伤的治疗,关键在于早诊断及早治疗,疑有腘动脉损伤者尽早探查;对伴有足踝部软组织及踝关节损伤,或足底难以恢复保护性感觉,估计小腿肌肉会发生广泛的坏死和感染者,应考虑一期行截肢术。

Objective To explore the therapy procedure and the functional recovery of the limb with fractures around knee complicated with injury of popliteal artery,and to investigate the treatment perscription of limb salvage. Methods Twenty-seven patients with fractures around knee complicated with injury of popliteal artery were treated with emergent fixation and popliteal artery / vein repair. Of them,2 underwent amputation at lower level of thigh,and 1 at the level of knee. The other 24 patients＇ injured extremities were retained by means of 3- 5（ mean = 4） times of operation. Among the 24 patients,there were 3 patients who received repair with latissimus dorsi flap and the others had repair with caput mediale musculi gastrocnemii flap or local fascio-cutaneous flap.All the patients were followed-up for 12- 24（ 16 ± 2. 39） months. The leg function was evaluated by the standard of Puno. Results There were no deaths,three cases were amputated. The extremities were retained in 24 patients,4 of whom had foot-drop with bad functional assessment. Conclusion It is very important for the patients with fractures around knee complicated with injury of popliteal artery to be early diagnosed and surgically treated. The explorative operation must been taken as early as possible if the patients are suspicious of injury of popliteal artery. To the patients with ankle fracture and soft tissue injury or tibial nerve injury without protective sense,the operation of amputation was needed. If the muscles of the leg are widely necrosis or infected,amputation was also needed.