腘动脉损伤的诊断与治疗  

Diagnosis and treatment of popliteal artery injury

作　　者：侯晓蕾[1] 刘建龙[1] 贾伟[1] 田轩[1] 蒋鹏[1] 

机构地区：[1]北京积水潭医院血管外科,北京100035

出　　处：《中国普通外科杂志》2011年第12期1315-1318,共4页China Journal of General Surgery

摘　　要：目的探讨腘动脉损伤的早期诊断和治疗措施,以提高保肢率。方法回顾性分析2000年1月—2010年12月收治的168例腘动脉损伤患者临床资料,其中锐性伤27例(16.1%),钝性伤141例(83.9%),合并休克24例(14.3%),骨折/脱位125例(74.4%),神经损伤81例(48.2%),静脉损伤66例(39.3%)。比较不同受伤机制以及手术与非手术治疗的结果,分析致残的原因及与合并症的关系。结果血供完全恢复68例(40.5%),改善59例(35.1%),完全恢复率手术组(43.4%)高于非手术组(12.5%)(P<0.05)。截肢41例(24.4%),钝性伤截肢率(28.4%)明显高于锐性伤(3.7%)(P<0.05),手术组的截肢率(25.0%)与非手术组(18.8%)无明显差异;合并休克者截肢率(41.7%)高于无休克者(21.5%)(P<0.05),合并伴行静脉损伤者截肢率(33.3%)高于无静脉损伤者(18.6%)(P<0.05),合并骨折/脱位及神经损伤者截肢率与不合并者间无统计学差异(均P>0.05)。结论受伤至治疗的时间是影响预后的主要因素,相关合并症是致残的主要原因。早期诊断、彻底清创、恰当选择修复方法以及良好的创面覆盖是挽救肢体、减少伤残的有效措施。Objective To investigate the early diagnosis and treatment method of popliteal artery injury so as to improve the limb salvage rate.Methods The clinical data of 168 patients with popliteal artery injury treated in our hospital during January 2000 to December 2010 were retrospectively studied.Of the patients,27 cases（16.1%） were penetrating injury,and 141（83.9%） were blunt injury.The associated comorbidities included shock in 24 cases（14.3%）,fracture/dislocation in 125（74.4%）,nerve injury in 81（48.2%） and venous injury in 66 cases（39.3%）,respectively.The outcomes of different mechanisms of injury and surgical or non-surgical treatment were compared,and the causes of disability and their relations with the comorbidities were analyzed.Results The distal circulation was completely restored in 68 cases（40.5%）,partially improved in 59 cases（35.1%）,and the complete recovery rate of the patients who underwent surgical treatment（43.4%） was significantly higher than that of the patients who underwent non-surgical treatment（12.5%）（P0.05）.Amputation was performed in 41 cases（24.4%）.The amputation rate of the patients with blunt injury（28.4%） was significantly higher than that of patients with penetrating injury（3.7%）（P0.05）,while there was no statistically significant difference between the patients who underwent surgical treatment（25.0%） or non-surgical treatment（18.8%）.The amputation rate of patients with shock（41.7%） or with venous injury（33.3%） was significantly higher than that of the patients without shock（21.5%） or without venous injury（18.6%）,respectively（both P0.05）,while there was no statistically significant difference between the patients with fracture/dislocation or with nerve injury and the patients without fracture/dislocation or without nerve injury,respectively（both P0.05）.Conclusions The duration from injury to surgery is a main factor for prognosis,and the related comorbidities are main causes of disability.Early di

关 键 词：腘动脉/损伤 四肢救助 创伤和损伤/外科学 

分 类 号：R654.4[医药卫生—外科学]