老年股骨近端骨折术后动脉损伤8例报道并文献复习  

Postoperative artery injury in elderly patients with proximal femoral fractures:report of eight cases and review

作　　者：杨旭庆 张建永 张宇乾 曹国征 王庆贤[1] YANG Xu-qing;ZHANG Jian-yong;ZHANG Yu-qian;CAO Guo-zheng;WANG Qing-xian(Trauma Emergency Center,the Third Hospital of Hebei Medical University,Shijiazhuang,Hebei 050051,China)

机构地区：[1]河北医科大学第三医院创伤急救中心,河北省骨科研究所,河北省骨科生物力学重点实验室,河北石家庄050051

出　　处：《中国骨与关节损伤杂志》2023年第2期131-135,共5页Chinese Journal of Bone and Joint Injury

摘　　要：目的观察老年股骨近端骨折患者术后动脉损伤的临床症状,并探讨动脉损伤的诊断与治疗方法。方法回顾性分析自2016-11—2019-11诊治的8例老年股骨近端骨折术后动脉损伤,5例股骨颈骨折行人工股骨头置换术,3例股骨粗隆间骨折行股骨近端防旋髓内钉内固定术。术后康复期间8例均出现动脉损伤症状,超声检查发现手术部位存在较大的血肿,进入手术室进行数字减影血管造影检查,找到出血动脉并予以弹簧圈栓塞止血,栓塞止血后视情况行血肿清除术。结果本组动脉损伤的症状在骨折术后2~17 d出现,动脉损伤在骨折术后2~19 d确诊并接受治疗。动脉数字减影血管造影结果显示,2例左臀上动脉和臀下动脉损伤,1例右臀上动脉分支损伤,2例右臀下动脉分支损伤,3例股深动脉分支损伤。栓塞止血后4例等待血肿自行吸收,4例栓塞后即行血肿清除术。住院期间1例未输注悬浮红细胞,其余7例输注悬浮红细胞6~16 U,平均10.6 U。术后6个月随访时所有患者均未出现动脉损伤复发迹象。结论老年股骨近端骨折患者术后动脉损伤的临床表现不具有特异性,出现时间不确定,临床医师应该提高警惕。确诊动脉损伤后,利用微创血管介入技术明确出血位置、栓塞止血非常重要,同时需要根据患肢肿胀程度、神经受压情况以及患者基础状况慎重进行血肿清除术。Objective To observe the clinical symptoms of arterial injury in elderly patients with proximal femoral fractures after operation,and explore the diagnosis and treatment of arterial injury.Methods A retrospective analysis was made of 8 elderly patients with arterial injury after operation of proximal femoral fractures treated from November 2016 to November 2019,5 cases of femoral neck fractures were treated with artificial femoral head replacement,and 3 cases of intertrochanteric fractures were treated with proximal femoral anti-rotation nail internal fixation.During postoperative rehabilitation,all 8 cases showed symptoms of arterial injury,and ultrasound examination found large hematoma at the surgical site.The bleeding artery was found in the operating room by digital subtraction angiography,and coil embolization was performed to stop bleeding.After embolization,hematoma removal was performed according to the situation.Results The symptoms of arterial injury appeared 2-17 days after fracture surgery,and the arterial injury was diagnosed and treated 2-19 days after fracture surgery.The results of digital subtraction arterial angiography showed that 2 cases had left superior gluteal artery and inferior gluteal artery injuries,1 case had right superior gluteal artery branch injuries,2 cases had right inferior gluteal artery branch injuries,and 3 cases had femoral deep artery system injuries.After embolization and hemostasis,4 patients waited for hematoma absorption,and 4 patients underwent hematoma removal immediately.During hospitalization,1 case received no transfusion of suspended erythrocytes,and the other 7 cases received infusion of 6-16 U,with an average of 10.6 U.No recurrence of arterial injury was observed in all patients at 6 months after the operation.Conclusion The clinical manifestations of postoperative arterial injury in elderly patients with proximal femoral fractures are non-specific and the time of occurrence is uncertain.Clinicians should be vigilant.After the diagnosis of arterial injury,it i

关 键 词：股骨近端骨折 人工股骨头置换术 股骨近端防旋髓内钉 动脉损伤 微创血管介入技术 

分 类 号：R687.3[医药卫生—骨科学]