腘动脉断裂基于下肢CTA影像的早期诊治及临床分型

Early diagnosis and clinical classification of popliteal artery rupture based on bilateral lower limb CTA

目的总结分析基于下肢CTA影像的腘动脉断裂的早期诊治方法及临床分型依据、分型方法。方法回顾性分析2015年8月-2019年3月对疑似临床腘动脉断裂的45例45肢患者临床资料,急诊行下肢CTA检查,确诊腘动脉断裂患者42例;依据术前CTA影像腘动脉断裂部位、延续支损伤情况,将腘动脉断裂进行临床分型;术中依据临床分型,取合适长度的对侧大隐静脉用于桥接血管,行骨折或关节脱位复位固定、血管神经显微外科修复、部分患者小腿切开减压并二期处理减张创面。术后随访,复查下肢CTA检查评估血管情况,依据膝关节HSS评分评价膝关节功能,分析总结临床腘动脉断裂患者临床分型准确率、与骨折或脱位关系、保肢肢体功能等。结果确诊腘动脉断裂患者42例,术后39例患肢成活,2例因肌肉严重坏死行截肢术,1例因吻合口二次撕裂出血行截肢术。保肢率92.9%,其中31例行二期直接缝合或游离植皮。术后39例行患肢CTA检查,吻合血管通畅,与临床分型相吻合;2例行膝关节松解术,5例行膝关节交叉韧带重建术,2例行骨不连植骨内固定术;随访12~18个月,平均15个月,随访患者35例,失访4例;按膝关节HSS评分膝关节功能:优19例,良8例,可5例,差3例,优良率77.1%。结论基于下肢CTA影像的腘动脉断裂临床分型能准确概括腘动脉断端位置及延续支损伤情况,并能评估血管缺损长度及侧支循环情况,利于临床腘动脉损伤的早期诊断及手术治疗,取得满意的临床疗效,具有良好的临床指导意义。

Objective To summarize and analyze the early diagnosis and treatment methods of popliteal artery rupture based on lower limb CTA,clinical classification basis and classification methods.Methods From August 2015 to March 2019,45 patients with suspected clinical popliteal artery rupture were retrospectively analyzed,including 45 limbs.Emergency CTA examination of lower limbs confirmed 42 cases of popliteal artery rupture.According to the location of popliteal artery rupture and the injury of the continuing branch on preoperative CTA images,the popliteal artery rupture was clinically classified.During the operation,according to the clinical classification,the contralateral great saphenous vein of appropriate length was used to bridge blood vessels,and fracture or joint dislocation was reduced and fixed,and vascular and nerve microsurgical repair was performed.In some patients,the leg was cut open and decompressed,and the tension reduction wound was treated in the second stage.During postoperative follow-up,CTA examination of both lower limbs was performed to assess vascular conditions,knee function was evaluated according to knee HSS score,and clinical classification accuracy of patients with clinical popliteal artery rupture,its relationship with fracture or dislocation,and limb sparing function were analyzed and summarized.Results Forty-two cases of popliteal artery rupture were diagnosed.After operation,39 patients survived,2 patients underwent amputation due to severe muscle necrosis,and 1 patient underwent amputation due to anastomotic second tear bleeding,the limb saving rate was 92.9%.Thirty-one patients underwent secondary direct suturing or free skin grafting.CTA examination was performed in 39 patients after operation,and anastomotic vessels were unobstructed,which was consistent with clinical classification.2 patients underwent knee joint release,5 patients underwent knee cruciate ligament reconstruction,and 2 patients underwent internal fixation with nonunion bone graft.35 patients were followed up for 12 to 18 months,with an average of 15 months.4 patients were lost to follow-up.According to the knee HSS score,the knee function was excellent in 19 cases,good in 8 cases,fair in 5 cases and poor in 3 cases,with an excellent and good rate of 77.1%.Conclusion The clinical classification of popliteal artery rupture based on lower limb CTA can accurately summarize the position of the popliteal artery rupture and the injury of the continuation branch,and evaluate the length of the vascular defect and collateral circulation,which is conducive to the early diagnosis and surgical treatment of the popliteal artery injury,achieve satisfactory clinical efficacy and have good clinical guiding significance.