影响四肢主要动脉损伤修复术后早期肢体血运的术前危险因素研究  

Preoperative risk factors for early extremity blood supply after repair of major arterial injury

作　　者：邓佩军 杨建涛[1] 秦本刚[1] 王洪刚[1] 李平[1] 戚剑[1] 顾立强[1] 朱庆棠[1] Deng Peijun;Yang Jiantao;Qin Bengang;Wang Honggang;Li Ping;Qi Jian;Gu Liqiang;Zhu Qingtang(Department of Microsurgery,Orthopaedic Trauma and Hand Surgery,The First Hospital Affiliated to Sun Yat-sen University Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology,Orthopaedic Research Institute,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院显微创伤手外科、广东省骨科学重点实验室,广州510080

出　　处：《中华创伤骨科杂志》2022年第3期247-252,共6页Chinese Journal of Orthopaedic Trauma

基　　金：广东省卫生计生适宜技术推广项目。

摘　　要：目的探讨影响四肢主要动脉损伤修复术后早期肢体血运的术前危险因素,以期为预防动脉修复术后发生肢体血运障碍提供线索。方法回顾性分析2003年1月至2019年12月期间中山大学附属第一医院显微创伤手外科收治的139例(140侧肢体)四肢主要动脉损伤伴肢端缺血患者资料。男112例,女27例;中位年龄为30(20,44)岁。以术后患肢早期(48 h内)是否发生血运障碍为主要结局指标,将患者性别、年龄、缺血时间、损伤机制、损伤部位、是否伴发骨折、软组织损伤情况、手术时间等进行单因素分析,再将P<0.1的因素纳入logistic回归分析,P<0.05认为差异有统计学意义。结果44侧(31.4%,44/140)肢体在术后48 h内发生血运障碍。术后肢体发生血运障碍与未发生血运障碍患者的损伤机制、缺血时间、是否伴发骨折、软组织损伤情况比较差异均有统计学意义(P<0.05)。Logistic回归分析结果显示:钝性伤(OR=5.639,95%CI:1.068~29.761,P=0.042)和周围软组织缺损(OR=12.568,95%CI:3.402~46.431,P<0.001)是四肢主要动脉损伤修复术后早期肢体发生血运障碍的术前危险因素。结论钝性伤和周围软组织缺损是四肢主要动脉损伤修复术后早期肢体发生血运障碍的术前危险因素,在诊断及制定手术方案时应重点关注。Objective To investigate the preoperative risk factors affecting early extremity blood supply after repair of major arterial injury so as to provide clues for prevention of limb ischemia.Methods The clinical data were retrospectively analyzed of the 139 patients(140 extremities)with major extremity arterial injury who had been admitted to Department of Microsurgery,Orthopaedic Trauma and Hand Surgery,The First Hospital Affiliated to Sun Yat-sen University from January 2003 to December 2019.There were 112 males and 27 females,with a mean age of 30(20,44)years.The primary outcome was the early status of blood supply to the injured extremity(48 hours after surgery).Univariate analysis was conducted of such factors as gender,age,ischemia time,injury mechanism,injury site,fracture,soft tissue lesion,and duration of surgery.The significant factors(P<0.1)were then analyzed by logistic regression,and P<0.05 was considered statistically significant.Results Ischemia happened in 44(31.4%,44/140)extremities within 48 hours after surgery.There were significant differences in injury mechanism,ischemia time,fracture,and soft tissue lesion between patients with and without postoperative extremity ischemia(P<0.05).Logistic regression analysis indicated that blunt injury(OR=5.639,95%CI:1.068 to 29.761,P=0.042)and soft tissue lesion(OR=12.568,95%CI:3.402 to 46.431,P<0.001)were significant preoperative risk factors affecting the early blood supply after repair of major extremity arterial injury.Conclusion As blunt injury and soft tissue defect are preoperative risk factors for early extremity ischemia after repair of major extremity arterial injury,surgeons should pay more attention to them when assessing patients and making repair protocols.

关 键 词：四肢 动脉损伤 肢体缺血 损伤机制 软组织损伤 危险因素 

分 类 号：R654.4[医药卫生—外科学]