血管腔内治疗隐匿性动脉损伤的临床效果

Clinical characteristics of latent artery injury in orthopaedics and the efficiency of intra-arterial therapy

目的 探讨血管腔内治疗隐匿性动脉损伤的临床效果。方法 收集自2010年6月至2014年10月血管腔内治疗13例隐匿性动脉损伤的患者资料，男9例，女4例；年龄19~75岁，平均（45.6±15.7）岁；损伤部位：臀上动脉4例，闭孔动脉2例，锁骨下动脉2例，股深动脉2例，股动脉1例，腘动脉1例，肱动脉1例；依据张英泽隐匿性血管损伤分型：B型6例，C型7例。所有患者均行动脉造影以明确诊断，受伤至确诊时间为2~70 h，平均16.0 h，同时选择覆膜支架、弹簧圈、明胶海绵栓塞方法行血管腔内治疗；术后采用彩色多普勒超声、CTA或DSA检查评估血管功能并记录临床并发症发生情况。 结果 13例均顺利完成手术，手术时间为30~60 min， 平均40 min；治疗期间，10例进行输血，输血量800~14 000 ml，平均3 200 ml。13例患者均获得随访，随访时间为3~24个月，平均为（7.3±5.8）个月。13例中采用覆膜支架治疗5例、弹簧圈5例、弹簧圈联合明胶海绵3例；所有患者动脉出血均得到控制，7例休克患者症状立即得到改善，5例患者术后发生腔隙感染经反复清创后治愈，1例腘动脉断裂患者因热缺血时间较长最终行膝下截肢，1例患者术后出现部分臀肌坏死合并MODS，最终治愈。至末次随访，13例患者无覆膜支架移位、血管闭塞及内漏现象发生。结论 隐匿性动脉损伤早期具有闭合性、迟发性、不典型性等特点，漏诊率高。动脉造影是诊断的金标准，血管腔内治疗后疗效满意、复发率低、并发症少，是治疗隐匿性B型以及C型非主干动脉损伤的有效手段。

Objective To observe clinical characteristics of orthopaedic patients with latent artery injury and evaluate the efficiency of intra-arterial therapy. Methods Data of 13 orthopaedic patients with latent vascular injury who were enrolled in our hospital from June 2010 to October 2014 were retrospectively analyzed. There were 9 males and 12 females with an average age of 45.6 years（19-75 years）. The affected arteries included superior gluteal artery （4 cases）, obturator artery （2 cases）, subclavian artery （2 cases）, femoral profound artery （2 cases）, femoral artery （1 case）, popliteal artery （1 case） and brachial artery （1 case）. According to the classification of systematic arterial injuries by Zhang Yingze, there were 6 cases of Type B and 7 cases of Type C. All patients were comfirmed by angiography with an average time of 16 hours （2-70 h） from primary injuries, and had undergone intra-arterial therapy with covered stent, spring coil and gelfoam. The functioning of arteries evaluated by ultrasound, CTA or DSA and the complication were recorded. Results Bleeding was successful controlled in 5 cases with covered stent, 5 cases with spring coil and 3 cases with spring coil and gelfoam. 7 cases with shock were improved immediately. 5 cases suffering lacunar infection were cured after repeated debridement. 1 case with popliteal artery rupture had amputation due to the long warm ischemia time. 1 case had gluteus muscular necrosis and secondary MODS, but recovered after treatment. All patients were followed up for 3-24 months with an average period of 7.3 months. No displacement of the stent, vascular occlusion and leakage were found. Conclusions Because latent artery injuries at an early stage are characterized by closure, delay and untypicality, they are often missed. Angiography is the gold standard for diagnosis. Intra-arterial therapy is an effective intervention for patients with latent non-major arterial injuries of Type B and C, and there are less recurrences and complications.