腘动脉损伤32例临床分析  

Clinical analysis of 32 cases of popliteal artery injury

作　　者：谷艳超 刘世清[1] 明江华[1] 周炎[1] 廖琦[1] 陈庆[1] 王钢[1] 

机构地区：[1]武汉大学人民医院骨三科,武汉430060

出　　处：《创伤外科杂志》2017年第1期55-58,共4页Journal of Traumatic Surgery

摘　　要：目的探讨腘动脉损伤的诊疗方法及临床疗效。方法回顾性分析2005年1月~2015年1月收治的32例腘动脉损伤患者临床资料,其中男性28例,女性4例;年龄25~56岁,平均35.5岁;左侧14例,右侧18例;开放性损伤12例,闭合性损伤20例;血管损伤分型:A型17例,B型5例,C型10例;腘静脉损伤17例,合并膝关节周围骨折26例。30例患者行急诊手术治疗,术中探查腘血管、神经,其中行腘动脉端端吻合11例,大隐静脉移植19例,2例一期截肢。对17例合并腘静脉损伤进行修复,骨折行外固定支架固定,同时行骨筋膜室切开减压,创面负压封闭引流技术覆盖。结果 32例患者无一例死亡,29例保肢成功;2例因受伤>12h下肢肌肉坏死严重,全身并发症或急性肾衰竭予以一期截肢;1例保肢术后出现肌肉广泛坏死、急性肾衰竭予以截肢。30例获得随访,随访时间6~24个月,平均15个月。26例合并骨折患者中25例获骨性愈合,1例发生骨不连,二期行植骨及接骨板内固定后愈合。末次随访对29例保肢成功患者进行Hohl膝关节功能评分,优11例,良8例,可6例,差4例,优良率65.5%。结论早期诊断、急诊手术重建下肢血供、术后密切观察及护理可提高腘动脉损伤治疗的成功率。Objective To summarize the treatment and clinical effects of popliteal artery injury. Methods Totally 32 patients with popliteal artery injury who had been admitted to our hospital between Jan. 2005 and Jan. 2015 were retrospectively analyzed, including 28 males and 4 females with an average age of 35. 5 （ 25-56 ） years. Fourteen were on the left side and 18 were on the right side. Twelve cases were open injury and 20 cases were closed injury. According to the vascular injury type classification, 17 were type A,5 cases were type B, and 10 cases were type C. In the 32 patients,17 cases were associated with injury of great saphenous vein and 26 patients were associated with fractures around the knee joint. Thirty patients underwent emergency surgery, and popliteal blood vessels and nerves were detected during the operation. Among them, 11 cases were conducted end-to-end anastomosis, 19 patients were performed transplantations of great saphenous vein, and 2 cases were conducted amputation immediately. Popliteal vein injury in 17 cases was repaired. Fractures were treated with external fixator, and the bone fascia room were cut for decompression,following by negative pressure drainage technology. Results All 32 patients survived. Twenty- nine patients obtained succcessful limb salvage. Two patients underwent amputation owing to serious complication and acute renal failure. One case of limb-salvage surgery underwent amputation for muscle necrosis and acute renal failure. Thirty cases were followed up for 6 to 24 months, average 15 months. Fracture in 25 patients healed. One patient suffered bone nonunion and bone defect got bone union after treated by fracture fixation and bone graft. Dur ing the last follow-up,29 cases were evaluated with Hohl score. Eleven cases were excellent, 8 cases were good,6 cases were fair and 4 cases were poor, the excellent and good rate was 65.5%. Conclusion Early diagnosis, emergency reconstruction of lower limb blood supply, close postoperative observation and nursing can improve t

关 键 词：腘动脉损伤 骨筋膜室综合征 诊断 

分 类 号：R654.3[医药卫生—外科学]