分步拉伸法治疗腘动脉创伤缺损的临床疗效  

Treatment of traumatic lesions of popliteal artery by staged stretching

作　　者：王建兵 顾三军 殷渠东 徐可林 李海峰 孙振中 芮永军 Wang Jianbing;Gu Sanjun;Yin Qudong;Xu Kelin;Li Haifeng;Sun Zhenzhong;Rui Yongjun(Department of Orthopaedics,The 9th People's Hospital of Wuxi,Wuxi Hand Surgery Hospital,Wuxi 214063, Jiangsu,China)

机构地区：[1]无锡市第九人民医院,无锡市手外科医院骨科,214063

出　　处：《中华创伤骨科杂志》2019年第1期81-84,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨应用分步拉伸法治疗腘动脉创伤缺损的疗效。方法回顾性分析2011年7月至2016年3月无锡市第九人民医院骨科治疗的29例腘动脉创伤缺损的患者资料。男19例,女10例;年龄16~61岁,平均38.3岁。腘动脉缺损长度2~5cm,平均3.7cm。术中利用外固定支架固定膝关节于屈曲位,适当游离后直接吻合腘动脉断端,术后4周开始分步间断调整外固定支架至膝关节伸直位,逐渐拉伸血管至原来长度。术后严密观察足趾的颜色、皮温、趾腹张力、毛细血管反应等情况。术后6个月行CT血管造影(CTA)检查。术后12个月对伤肢膝关节和踝关节主动活动范围进行评估。结果所有患者均获随访,随访时间1~3年,平均2年。所有肢体血供恢复良好,分步拉伸过程中无吻合口破裂、血管痉挛或血栓形成,术后6个月CTA显示腘动脉通畅,无假性动脉瘤、动脉及静脉瘘形成。术后12个月膝关节功能:优15例,良10例,中4例。踝关节的功能:优18例,良8例,中3例。结论应用分步拉伸法治疗腘动脉创伤缺损是一种简单、有效的方法。Objective To investigate the clinical effects of treating traumatic lesions of the popliteal artery by staged stretching.MethodsFrom July 2011 to March 2016, 29 patients with traumatic lesion of the popliteal artery underwent staged stretching after direct end to end anastomosis at Department of Or-thopaedics, The 9th People's Hospital of Wuxi. They were 19 males and 10 females, with a mean age of 38.3 years (range, from 16 to 61 years). The average length of popliteal artery lesions was 3.7 cm (range, from 2 to 5 cm). After the keen joint was immobilized at flexion by external fixation, direct end to end anastomosis was performed with a proper segmental vascular freedom. From 4 weeks after operation, the popliteal artery was stretched stage by stage to its original length by gradual adjustment of the external fixation till the knee joint was fully extended. The color, skin temperature, pulp tension and capillary reaction of the toes were closely observed after surgery. CT angiography (CTA) was performed 6 months after surgery. The active range of motion was assessed at 12 months after surgery for the knee and ankle joints on the injured limb.ResultsAll the patients were available for an average follow-up of 2 years (range, from 1 to 3 years). Blood supply was good for all the affected limbs. The staged stretching of the popliteal artery resulted in no rupture of any anastomotic stoma or no thrombus. CTA at 6 months after surgery showed fine patency of the popliteal artery and no formation of false aneurysm or arteriovenous fistula. At 12 months after surgery, the knee function was excellent in 15 cases, good in 10 and fair in 4;the ankle function was excellent in 18 cases, good in 8 and fair in 3.ConclusionStaged stretching is a safe, convenient and effective treatment of traumatic lesions of the popliteal artery.

关 键 词：腘动脉 膝损伤 踝损伤 分步拉伸 

分 类 号：R654.4[医药卫生—外科学]