四肢大血管伤诊断及治疗方法的选择对患者运动功能保全的意义

Significance of diagnosis and treatment of great vascular injuries in extremities on patient's motor function

目的:探讨四肢血管损伤后诊断和治疗方法的选择,对患者术后运动功能及生活质量的影响。方法:根据受伤部位、伤肢温度、末梢循环和动脉搏动情况,以及缺血时间长短,对患者的肢体损伤和创面进行检查。在一定的临床经验积累下,选择外科手术方法和手术技巧;术后指导患者进行肢体功能锻炼,并对其生活质量进行评估。结果:对22例四肢大血管损伤患者进行早期诊断和积极手术后,21例保肢成功;1例因吻合血管过少而第4、5足趾及足跟皮肤坏死。与其他手术技巧相比,本临床经验的成功率为95.5%(21/22),明显高于传统方法。另有3例由于缺血时间太长而截肢。对截肢患者进行运动功能训练,半年后肌力恢复达Ⅳ+,1年后皮肤瘢痕软化,对患者的生活质量进行评估的结果明显优于未行功能训练者。结论:四肢血管损伤的早期诊断十分重要,其有利于对患者进行更确实有效的手术治疗和保肢锻炼。探查伤处血管前,先控制远、近端出血,可使术野清晰、减少失血量,亦可提高患者的肢体保护。轻易结扎知名血管对患者末梢循环有不利影响。筋膜间隙切开可有效防止筋膜间隙综合征的发生。运用此经验对患者的肢体保护和治疗后的功能锻炼,以及生活质量的提高有实践意义。

AIM: To explore the effect of early diagnosis and treatment of vascular injury in extremities on patient's motor function and quality of life (QOL). METHODS: Twenty five patients, 9 males and 16 females with an average age of 27 years, were enrolled in the study. The injury and wound of limbs were checked depending on the site of a penetrating wound or blunt injury in the extremity, temperature, pulse and the time required for skin capillary refill in the distal digits. Surgical skills were chosen, the functional exercises of involved limb were conducted and QOL of patients was assessed.RESULTS: Twenty one of total 22 cases of vascular injury were uneventful following early diagnosis and active operation except one of necrosis of fourth and fifth toes and heel skin because of the lack of anastomotic vessels. The survival rate of this surgery was 95.5% ( 21/22) , higher than that of traditional one.Three cases admitted from other hospital were amputated because of ischemia for a long time. The amputated patients were guided to do exercises. After 6 months, myodynamia was restored to Ⅳ + , and malacia of skin scar completed at 1 year postoperatively. The assessing result of QOL in patients with exercise was better than that of patients without exercise.