全膝关节置换术后损伤性腘动脉假性动脉瘤处理的研究进展

Research progress on the management of injured popliteal artery pseudoaneurysm after total knee arthroplasty

动脉损伤是全膝关节置换术(total knee arthroplasty,TKA)罕见的并发症,其发生率为0.03%~0.20%[1-2]。动脉损伤最常见的损伤方式主要来源于器械外力的直接损伤,例如动脉撕裂伤、横断、撕脱或压迫等。动脉损伤会导致随后的血栓形成和急性肢体缺血[3]。在一些罕见情况下,动脉损伤还会导致假性动脉瘤的形成。腘动脉在腘血管神经束中处于最前方,是最靠近前方TKA工作区域的结构。因此TKA术中发生动脉损伤最常见的部位为动脉[4]。

Although traumatic popliteal pseudoaneurysm after total knee arthroplasty is rare,the result is always catastrophic.There are many high-risk factors of popliteal artery pseudoaneurysm,including existing peripheral vascular disease,no dorsal artery pulsation before surgery,popliteal aneurysm,revision surgery,use of anticoagulants,prolonged tourniquet time,etc.Popliteal artery pseudoaneurysms are often caused by direct damage to blood vessels,such as electric drills,rongeurs,posterior plate hooks,swing saws,fixation nails used to fix tibial clamps,screws used in non-cemented tibial prostheses,heat generated by cement or repeated local trauma.Early recognition of popliteal artery pseudoaneurysms is very important and difficult,because popliteal artery pseudoaneurysms may be asymptomatic.If symptoms appear,they will present with delayed signs rather than acute signs.At the same time,the clinical manifestations of popliteal artery pseudoaneurysm can be confused with postoperative deep vein thrombosis(DVT)or early postoperative hematoma formation,so surgeons should pay attention to this situation.For traumatic pseudoaneurysms,there are many treatment options including open repair,ultrasound-guided compression,percutaneous thrombin injection,intratumoral coil embolization,stent graft implantation,and combined use of percutaneous thrombin injection.Doctors need to be familiar with high-risk factors and injury mechanisms,focus on assessing preoperative vascular conditions,pay attention to operational details during the operation such like the placement of hooks,avoid excessive knee flexion or extension,etc.,which are essential to reduce the incidence of complications and diagnosis interval.For patients with clinical manifestations of compartment syndrome or DVT,it is necessary to consider the possibility of popliteal artery pseudoaneurysm,and the popliteal artery pulsation should be checked as soon as possible with the Doppler.