开放性动脉损伤的显微修复的疗效分析  

The analysis of curative effect of open popliteal artery injury treated by microsurgical repair

作　　者：杜晓龙[1] 宋涛[1] 欧学海[1] 樊靖峤[1] 刘亚飞[1] Du Xiaolong Song Tao Ou Xuehai et al(Department of Orthopaedics, Microsurgical Repair of Bone, Xi＇an Honghui Hospital, Xi＇an Jiaotong University Health Science Center, Xi＇an 710054, China)

机构地区：[1]西安交通大学医学部附属红会医院骨显微修复外科,710054

出　　处：《美中国际创伤杂志》2016年第3期12-13,17,共3页U.S.Chinese International Journal of Traumatology

摘　　要：目的：回顾性分析膝部开放性骨折脱位合并胭动脉损伤的治疗方法和效果。方法：本组35例，男28例，女7例；年龄9～68岁，平均34．8岁。骨折脱位情况：股骨下端骨折10例，胫骨上端骨折17例，浮膝8例。动脉修复方法：端端吻合11例，大隐静脉移植24例。骨折及脱位固定方法：内固定4例，外固定架固定31例。修复顺序：先修复血管，再使用外固定支架或者斯氏针固定骨折及脱位。结果：所有患者均获随访，随访时间1～3年，平均1．5年。肢体存活31例（88．6％），截肢4例。截肢者均为入院时肢体严重缺血患者，部分缺血患者无1例截肢；截肢患者中有3例合并严重软组织损伤，1例合并中度软组织损伤；肢体存活患者平均MESS评分（4．7±1．4）分，截肢患者平均（7．5±1．7）分。截肢患者均是由于术后出现难以控制的感染而截肢。结论：膝部骨折脱位合并胭动脉损伤时，肢体的软组织损伤程度、MESS评分、肢体缺血的严重程度均是影响肢体成活的重要因素，术后感染是造成截肢的重要要原因。Objective： To analyze the treatment method and effect of open fracture dislocation of the knee combine with popliteal artery injury, retrospectively. Methods： 35 cases emploed in this study, 28 male and 7 female, aged from 9 to 68 years, distal femoral fracture, proximal tibial fracture and floating knee in 10, 17 and 8 cases respectively. Artery repair methods： end-to-end anastomosis in 11 cases, great saphenous vein transplantation in 24 cases. Internal and external fixation in 4 and 31 cases, respectively. Sequence of artery repair： repair the blood vessel first, then fix the fracture with Kirschner wire or external fixator. Results： All the patients were foUowed-up for 1-3 years （mean 1.5 years ）. Limbs survived in 31 cases （88.6%）, amputation in 4 cases due to severe ischemia of the limbs on admission （with severe soft tissue injury in 3 cases and moderate injury in 1 case）, the average MESS score was （4.7±1.4） points in limb survival patients and was （7.5±1.7） points in amputation patients. The reason of amputation was uncontrollable postoperative infection. Conclusion： Knee fracture dislocation combine with popliteal artery injury, MESS score, the degree of soft tissue injury and the severity of ischemia of the limbs are the most important factors for limb survival, and also postoperative infection is a major cause of amputation.

关 键 词：胭动脉损伤 显微手术 膝关节 开放性骨折 

分 类 号：R654.3[医药卫生—外科学]