肢体血管严重创伤的救治策略(附93例报道)  

Diagnosis and treatment of vascular injuries of extremities(Report of 93 cases)

作　　者：何武兵[1,2] 张旭鸣[1,2] 邱美光[1,2] 陈曙光[1,2] 柯铁[1,2] 林昊[1,2] 林世水[1,2] 

机构地区：[1]福建省立医院急诊外科 [2]福建医科大学省立临床医学院,福建福州350001

出　　处：《中国骨与关节损伤杂志》2015年第3期287-290,共4页Chinese Journal of Bone and Joint Injury

基　　金：国家临床重点专科建设项目(2012-149);福建省自然科学基金计划资助项目(2010J01119)

摘　　要：目的探讨肢体血管严重创伤的诊断和救治。方法回顾性分析93例肢体血管急性严重创伤的诊断和救治。包括动脉损伤87例98条,静脉损伤33例36条,动静脉合并损伤30例,合并神经损伤50例,合并骨折脱位23例,合并肌腱、肌肉损伤51例,当地医院已行血管吻合术后肢体再缺血2例。71例（78.0%）重建损伤血管在6 h之内。91例行保肢手术,2例一期截肢。Fogarty球囊导管动静脉取栓8例,血管破裂修补6例,血管缺损修补成形术2例,血管切除吻合57例,自体静脉移植修复11例,人工血管移植修复8例,血管结扎3例,DSA栓塞4例,筋膜切开减压6例。结果感染15例（16.1%）,浅表感染6例,深部感染6例,骨髓炎3例,二期截肢1例,死亡2例（2.2%）。78例获得随访3个月~3年,（1.62±0.73）年,73例重建循环的肢体均可触及远端动脉的搏动,肢端肤色正常,术后肢体功能恢复正常或基本恢复正常59例（75.6%）,术后肢体部分功能障碍17例（21.8%）,术后发生肢体缺血性挛缩2例（2.6%）。结论肢体血管严重损伤,快速明确诊断是血管损伤抢救治疗的前提,急救处理得当是血管损伤治疗的基础,损伤血管的正确修复是血管治疗的关键,合理防治术后并发症是血管损伤救治成功的保障。手术不及时和伴有广泛的骨骼、神经、软组织损伤及感染是截肢率、致死率高的重要原因。Objective To evaluate the effect of early diagnosis and surgical treatment of vascular injuries of extremities.Methods The diagnosis and emergency treatment and revascularization and postoperative treatment methods of 93 patients with vascular injuries of the extremities were analyzed retrospectively. A total of 98 arterial injuries in 87 cases, 36 venous injuries in 33 cases, arterial and venous injuries in 30 cases, with nerve injuries in 50 cases, fracture dislocation in 23 cases,and tendon and muscle lesions in 51 cases were evaluated. Extremity ischemia was observed in 2 cases after vascular anastomosis in local hospital. Injuried arteries of 71 cases（78.0%） were reconstructed less than 6 hours after trauma. Extremity preservation was performed in 91 cases, and primary amputation was done in 2 cases. Embolectomy of artery and vein in 8cases was done with fogarty catheter. Damage blood vessel was repaired directly in 6 cases. Blood vessel neoplasty was done in defect vessel in 2 cases. Damage blood vessel section was trimmed with vascular anastomosis directly in 57 cases.Reconstruction of damage blood vessel was performed with autovein vessel in 11 cases and vascular prosthesis in 8 cases.Vascular deligation was done directly in 3 cases. Blood vessel embolism was adopted under DSA in 4 cases. Pen decompression operation in bone anadesma room was done in 6 cases. Results Infection was observed in 15 cases（16.1%） in93 patients, with 6 superficial infection, 6 deep infection, 3 osteomyelitis. Secondary amputation was adopted in 2 cases. Two cases（2.2%） were dead. Seventy eight patients achieved good follow-up from 3 months to 3 years, average（1.62 ±0.73）years.According to motion and sense rating, good in 59 patients（75.6%）, part impairment in 17 patients（21.8%）, Volkmann＇s syndrome in 2 patients（2.6%） were observed. Conclusion Early accurate diagnosis was precondition, suitable first aid is foundation, correct revascularization was key point, effective post-operation management, pr

关 键 词：血管损伤 诊断 抢救 外科手术 教训 

分 类 号：R654.3[医药卫生—外科学]