下肢创伤中动脉损伤平面对肢体远端血供的影响  

The impact of arterial injury level on blood supply of distal limb in lower limb trauma

作　　者：刘利国[1] 张秀军[1] 黄梅[1] 李俊海[1] 赵子源[1] 黄俊杰[1] 刘存发[1] 李楠[1] 肖磊[1] 孔敬波[1] Liu Liguo;Zhang Xiujun;Huang Mei;Li Junhai;Zhao Ziyuan;Huang Junjie;Liu Cunfa;Li Nan;Xiao Lei;Kong Jingbo(Department of Vascular Surgery, Tianjin Hospital, Tianjin 300211, China)

机构地区：[1]天津市天津医院血管外科,300211

出　　处：《中华骨科杂志》2019年第7期429-435,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨下肢创伤中动脉损伤平面对肢体远端血供的影响。方法回顾性分析2014年6月至2017年8月收治的有不同程度动脉损伤的下肢创伤患者93例,男84例,女9例;年龄(43.54±9.90)岁(范围25~65岁),经开放手术方式进行血运重建。根据动脉损伤部位将患者分为三组:近端血管组,股浅动脉起始至股浅动脉分出膝降动脉及直接骨膜支前;中间血管组,自股浅动脉分出两大侧支后至腘动脉分出膝下内侧动脉前;远端血管组,腘动脉分出膝下内侧动脉后至腓动脉末梢水平。三组患者的受伤至血运重建时间分别为(13.67±5.99)h、(11.15±4.43)h、(11.92±5.48)h,组间差异无统计学意义(F=1.564,P=0.215);三组患者肢体损伤严重程度评分分别为(13.00±3.74)分、(12.77±3.81)分、(11.50±3.99)分,组间差异无统计学意义(F=1.445,P=0.241)。比较三组术后肌酸激酶、动脉血乳酸水平及肢体切开减张率。结果中间血管组术后肌酸激酶为(8 743.15±6 968.48)u/L、近端血管组为(1 467.67±1 810.27)u/L、远端血管组为(2 893.51±1 304.56)u/L,中间血管组大于近端血管组和远端血管组,组间差异有统计学意义(F=22.587,P=0.000);中间血管组动脉血乳酸水平为(3.20±1.51)mmol/L、近端血管组为(1.63±0.46)mmol/L、远端血管组为(1.85±0.69)mmol/L,中间血管组大于近端血管组和远端血管组,组间差异有统计学意义(F=20.612,P=0.000);中间血管组肢体切开减张24例、未切开15例,近端血管组均未行切开减张,远端血管组切开减张15例、未切开21例,三组肢体切开减张率分别为61.5%、0、41.7%,组间差异有统计学意义(χ^2=19.156,P=0.000)。结论在下肢创伤中,中间节段血管(自股浅动脉分出两大侧支后至腘动脉分出膝下内侧动脉前)损伤对肢体远端血供的影响最严重。Objective To explore the impact of arterial injury on distal limb blood supply in lower limb trauma. Methods Retrospective analysis of 93 patients with different levels of lower limb arterial injury admitted to our hospital from June 2014 to August 2017. There were 84 males and 9 females aged 43.54±9.90 years (ranging 25-65 years). Revascularization was performed through open reduction. Patients were divided into three groups according to their arterial injury locations. Proximal vessels were along the superficial femoral artery, from its beginning to the point where it was divided into the descending genicular artery and direct periosteal branches. Intermediate vessels were from the dividing point on the superficial femoral artery to the popliteal artery before it was divided into the medial inferior genicular artery. Distal vessels were from the dividing point on the popliteal artery to the distal end of the peroneal artery. The duration from injury to revascularization in the three groups were 13.67±5.99 h, 11.15±4.43 h, and 11.92±5.48 h, respectively. There was no significant difference between groups (F=1.564, P=0.215). ISS in the three groups were 13.00±3.74, 12.77±3.81, and 11.50±3.99, respectively. There was no significant difference between groups (F=1.445, P=0.241). The following items were compared among the three groups, postoperative creatine kinase, arterial blood lactate and limb compartment cut. Results Creatine kinase of the intermediate vascular group was 8 743.15±6 968.48 u/L, proximal vascular group 1 467.67±1 810.27 u/L, distal vascular group 2 893.51±1 304.56 u/L. The data of intermediate vascular group were higher than those of proximal and distal vascular groups with significant difference among the groups (F=22.587, P=0.000). The lactate of the intermediate vascular group was 3.20±1.51 mmol/L, proximal vascular group 1.63±0.46 mmol/L, distal vascular group 1.85±0.69 mmol/L with significant difference among the groups (F=20.612, P=0.000). The compartment cut of the intermediat

关 键 词：血管系统损伤 创伤和损伤 血管移植术 

分 类 号：R658.3[医药卫生—外科学]