介入辅助手术治疗足趾闭合骨折合并动脉损伤危象  

INTERVENTION ASSISTANT OPERATION IN TREATMENT OF PHALANX CLOSED FRACTURE COMBINED WITH ARTERY CRISIS

作　　者：宓士军[1] 周广军[1] 高景春[1] 孙敬宇[1] 冯志永[1] 高万旭[1] 

机构地区：[1]唐山市丰润区人民医院骨三科,河北唐山064000

出　　处：《中国修复重建外科杂志》2010年第8期926-929,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨介入辅助手术治疗足趾闭合骨折合并动脉损伤危象的方法和疗效。方法 2002年8月-2008年12月,收治24例31趾足趾闭合骨折合并动脉损伤危象。男17例22趾,女7例9趾;年龄16～62岁,平均38岁。致伤原因:挤压及重物砸伤20例,交通事故伤3例,机器绞伤1例。其中趾19趾,第2足趾10趾,第3足趾2趾。受伤至入院时间1～10h,平均6.8h。采用Ven-O-Lit静脉留置针行足背动脉、胫后动脉穿刺后行足趾动脉造影,根据造影检查结果行相应处理。待局部血运建立后,根据骨折类型和部位,采用克氏针或钢板内固定。结果介入治疗后4、6d,各有1例1趾因坏死截趾,22例29趾保趾治疗成功。术后21例切口Ⅰ期愈合;1例切口有渗出,经局部换药3周后愈合。22例29趾术后获随访,随访时间1～6年,平均3.5年。其中2例3趾自觉足趾畏寒,遇冷后有疼痛及麻木感;其余足趾趾腹饱满、红润,点压回血正常,无冷痛及麻木感。2例2趾骨折不愈合,经植骨后愈合;其余骨折均于术后3～6个月愈合,平均4.5个月。结论足趾闭合骨折合并动脉损伤危象宜早发现、早处理,介入辅助手术是治疗此类损伤的一种有效方法 。Objective To explore the effectiveness and methods of intervention assistant operation in the treatment of phalanx closed fracture combined with artery crisis. Methods Between August 2002 and December 2008, 24 cases （31 toes） of phalanx closed fracture combined with artery crisis were treated. There were 17 males （22 toes） and 7 females （9 toes）, aged from 16 to 62 years （mean, 38 years）. The causes of injury included crush and bruise （20 cases）, traffic accident （3 cases）, and machine twist （1 case）. The locations were the first toe （19 toes）, the second toe （10 toes）, and the third toe （2 toes）. The period between injury and hospitalization was 1-10 hours （mean, 6.8 hours）. Phalanx angiography was performed by using venous indwelling needle for dorsalis pedis artery and posterior tibial artery puncture; according to angiography results, proper treatment could be done, then the constrast medium was injected to the artery to observe the blood supply. According to different types and locations of fracture, Kirschner wire and plate were choosen to fix fracture after the blood supply were recovered. Results Two cases （2 toes） received amputation due to necrosis at 4 days and 6 days after interventional therapy, respectively. Twenty-two cases （29 toes） survived. Incision healed primarily in 21 cases. Exudation occurred at wound of 1 case and was cured at 3 weeks after dressing change. Twenty-two cases （29 toes） were followed up 1-6 years （mean, 3.5 years） postoperatively. Two cases （3 toes） felt cool or anaesthesia and could not tolerate even in cold environment. The other toes had no senses of cold pain and paresthesia. Two cases （2 toes） had nonunion and achieved fracture healing after grafting bone. The mean union time was 4.5 months （range, 3-6 months） in other cases. Conclusion Intervention assistant operation is an effective measure in the treatment of phalanx closed fracture combined with artery crisis.

关 键 词：介入治疗 足趾骨折 动脉损伤危象 

分 类 号：R683[医药卫生—骨科学]