自体大隐静脉转流术治疗胫骨平台骨折合并腘动脉损伤疗效分析  

Efficacy of Autologous Great Saphenous Vein Bypass Surgery for Tibial Plateau Fracture Combined with Popliteal Artery Injury

作　　者：刘伟涛 孙岩 LIU Wei-tao;SUN Yan(Department of Hand and Foot Microsurgery,Heze Hospital of Traditional Chinese Medicine,Heze 274000,Shandong,China;Department of Vascular Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,Shandong,China)

机构地区：[1]菏泽市中医医院手足显微外科,山东菏泽274000 [2]山东第一医科大学附属省立医院血管外科,山东济南250021

出　　处：《中国现代手术学杂志》2022年第3期197-201,共5页Chinese Journal of Modern Operative Surgery

基　　金：山东省中医药科技发展计划(2019-0303,2019-0943);山东省医药卫生科技发展计划项目(2018WS273)。

摘　　要：目的探讨自体大隐静脉转流术治疗胫骨平台骨折合并腘动脉损伤的疗效。方法回顾性分析2018年1月至2021年1月收治的15例胫骨平台骨折合并腘动脉损伤患者的临床资料。术前8例行CTA,7例行彩色多普勒超声检查,提示腘动脉管腔部分闭塞6例,腘动脉管腔全部闭塞9例。所有患者均一期行腘动脉探查并自体大隐静脉转流术、跨膝关节外固定支架固定术,二期行切开复位内固定手术。术后定期随访,观察患侧肢体踝肱指数、皮肤温度、膝关节活动度等指标。结果本组均顺利完成一期腘动脉探查修复联合跨膝关节外固定支架固定术,术中探查见腘动脉断裂3例,腘动脉内膜损伤4例,腘动脉全层损伤8例。自体大隐静脉-腘动脉端端吻合术3例,自体大隐静脉-腘动脉旁路转流术12例。手术时间180~299 min,平均(243.53±33.72)min。术后患肢远端血液循环均稳定,术后即刻彩色多普勒超声提示肢体远端动脉血流通畅,无血管危象发生。术后均随访6个月,随访期内自体大隐静脉桥均未出现狭窄或闭塞。术后第1、6个月患肢踝肱指数及皮肤温度较术前明显改善(P<0.01),术后第6个月膝关节活动度较术后第1个月明显改善(P<0.01)。结论胫骨平台骨折合并腘动脉损伤应及早明确诊断并行一期修复治疗;自体大隐静脉转流术治疗腘动脉损伤效果较好。Objective To discuss the efficacy of autologous great saphenous vein bypass surgery in the treatment of tibial plateau fracture combined with popliteal artery injury.Methods The clinical data of 15 patients with tibial plateau fracture combined with popliteal artery injury hospitalized between January 2018 and January 2021 were analyzed retrospectively.Preoperative CTA was performed in 8 cases and color Doppler ultrasonography was in 7 cases,and the results showed partial occlusion of the popliteal artery in 6 cases and total occlusion of the popliteal artery in 9 cases.All patients were treated with popliteal artery exploration,autologous great saphenous vein bypass surgery and external brace fixation across the knee joint in the first stage,and open reduction and internal fixation surgery in the second stage.The ankle-brachial index(ABI),skin temperature,knee mobility,and other indicators of the injured limb were monitored on a regular basis following surgery.Results All surgery of the popliteal artery exploration and repair combined with external fixation with stent across the knee joint were performed successfully in the first-stage with the operation time of 243.53±33.72 min(ranged from 180 to 299 min).Autologous saphenous vein-popliteal artery end-to-end anastomosis surgery was performed in 3 cases,autologous saphenous vein-popliteal artery bypass surgery was in 12 cases.The blood circulation of the distal limb was stable after the operation,and the color Doppler ultrasound showed the distal limb artery flow was smooth without vascular crisis immediately after the surgery.No one was found stenosis or occlusion of the autologous great saphenous vein bridge during 6 months follow-up period.The ABI and skin temperature of the injured limb was improved significantly in the first and sixth month after the surgery than before the surgery(P<0.01),and activity of the knee joint was improved remarkable in sixth month than that in the first month after the surgery(P<0.01).Conclusions Early diagnosis and vascular rep

关 键 词：胫骨平台骨折 腘动脉损伤 大隐静脉转流术 

分 类 号：R683.42[医药卫生—骨科学] R654.4[医药卫生—外科学]