闭合性胭动静脉损伤2例治疗分析

目的 探讨闭合性胭动静脉钝性损伤的诊治方法。方法 本院近期收治闭合性胭动静脉钝性损伤2例，两例患者均有膝关节周围骨折，脑动静脉均系钝性损伤。结合受伤情况及临床检查以及多普勒超声检查，早期诊断，早期仔细修复损伤的血管，术中、术后抗凝治疗，以及术中预防性筋膜切开减压、预防感染等综合治疗。结果 1例截肢，1例发生缺血性肌坏死虽保住了肢体，但遗留有严重的肢体功能障碍。结论 闭合性胭动静脉钝性损伤应早期诊断，积极采取手术等综合治疗，降低并发症发生率和截肢率。     

四肢闭合性血管损伤的救治

目的：探讨四肢闭合性血管损伤的诊断、治疗。方法：对28例四肢闭合性血管损伤进行回顾性分析。结果：28例均行手术探查,分别行血管端端吻合术、单纯修补术、血管移植术。术后23例恢复良好,2例截肢,1例术后因切口并发症再次行人工血管移植后痊愈,2例死亡,其中1例死于休克、1例死于肺栓塞。结论：提高早期诊断率,积极进行血管修复,正确处理合并伤,防止并发症,可有效提高四肢闭合性血管损伤的救治疗效。     

腹部闭合性损伤手术治疗16例体会

目的 探讨对腹部闭合性损伤的病人及时诊断并手术治疗的临床意义.方法 根据16腹部闭合性损伤的病人诊疗分析.结果 明确病人的损伤作用机理、受伤部位,综合B超、CT及腹腔诊断性穿刺等检查,对病人做出及时、准确的诊断,有手术指征的病人,及时手术,术中进行了正确的处理.结论 对腹部闭合性损伤的病人,要早期做出正确的诊断,把握好手术指征,术中进行正确的处理,可提高病人的生存率及治愈率.     

闭合性胰腺外伤18例诊治分析

目的探讨闭合性胰腺外伤的诊断和治疗方法。方法对我院1991年6月至2006年6月收治的18例闭合性胰腺外伤的病例资料进行总结分析。结果18例中治愈17例,死亡1例。发生严重并发症6例(33.3%),其中胰瘘2例,腹腔脓肿1例,假性胰腺囊肿2例,假性胰腺囊肿伴大出血1例。结论早期腹部CT检查是诊断胰腺损伤最快捷、直观的方法,在剖腹探查术中常规探查胰腺是早期发现和避免漏诊胰腺外伤的关键。治疗时应综合考虑胰腺损伤的类型、合并伤和病人全身情况,选择合理的治疗方法。     

急性四肢动脉栓塞的外科治疗

目的：探讨急性肢体动脉栓塞的手术治疗效果和术后并发症的防治方法。方法：采用Fogarty球囊导管取栓治疗23例29条急性动脉栓塞肢体。术后所有患者均行溶栓、抗凝治疗。结果：本组无死亡。术后肢体存活23条，截肢3例、截趾3例；骨筋膜室综合征切开减压6例；术后出现急性心衰2例，脑梗塞3例，精神症状4例。23例均痊愈出院。随访1～6个月，23条成活肢体及6条残肢血供良好，功能正常。结论：早期诊断、及时手术治疗和术后对重要脏器功能的保护，是提高手术疗效、降低截肢率和死亡率的关键。     

闭合性小肠破裂24例诊治体会

目的 探讨闭合性小肠破裂的诊断与治疗问题。方法 回顾性分析24例闭合性小肠破裂患者诊断与手术治疗的临床资料。结果 均行手术治疗，术后并发切口感染3例，腹腔脓肿1例，感染性休克2例；治愈23例，死亡1例，死亡原因为感染性休克并多器官功能衰竭。结论 对闭合性腹部损伤致小肠破裂，早期诊断颇为重要，可明显降低死亡率；治疗应严格掌握手术指征，正确选择术式。     

四肢主要血管损伤的诊断及治疗

本文收治45例四肢血管损伤,除2例后遗缺血性肌挛缩,2例截肢外,其余肢体循环及功能良好。体会是:①早期正确诊断,特别是闭合性血管损伤,应严密观察,必要时可作Doppler超声波,动脉造影或手术探查。②早期修复及显微外科技术的应用使用血管重建成功率明显提高。③术后并发症的防治是提高手术成功率的一个重要条件,必须认真处理好合并伤和深筋膜切开术。     

动静脉转流术在下肢动脉硬化闭塞症中的作用

目的 探讨动静脉转流术治疗下肢动脉硬化闭塞症，研究其技术操作及临床应用。方法 对6例下肢动脉硬化闭塞症患者行Guo动脉胫后静脉转流术。结果 疗效优良5例，好转1例，术后只有一足趾截法。结论 此方法不易导致心衰，可挽救缺血肢体，避免截肢，疗效满意。     

钝性创伤性膈疝12例诊断与治疗

目的：探讨钝性创伤性膈疝的诊断治疗方法。方法：2008年9月-2011年12月我科收治钝性创伤性膈疝12例,对其临床资料进行旧顾性分析。结果：本组12例,术前胸部X线片检查确诊3例,胸部Crr检查确诊7例,手术中探查确诊2例。12例均手术修复破损膈肌,还纳移位脏器,其中1例合并有左下肺实变,予以左下肺叶切除;2例因降结肠、结肠脾曲嵌顿坏死,行坏死结肠切除,结肠外置。术后肺部感染2例,所有患者切口均愈合良好,均治愈出院。术后随访无复发,无一例死亡。结论：钝性创伤性膈疝可通过详细了解受伤原因、部位,全面细致的体格检查,以及X线、胸部CT等辅助检查及早明确诊断。钝性创伤性膈疝一旦确诊,应立即手术治疗,以修复破损膈肌,还纳移位脏器,减轻胸腔压迫,恢复循环、呼吸和消化功能。     

闭合性十二指肠损伤25例诊治体会

目的 探讨闭合性十二指肠损伤的诊断及治疗方法.方法 回顾性分析25例闭合性十二指肠损伤患者的临床资料.结果 25例均行手术治疗,治愈23例,死亡2例,术后出现并发症6例.结论 及时诊断及治疗是提高闭合性十二指肠损伤患者治愈率的关键.     

Loss of Distal Femur Combined with Popliteal Artery Occlusion: Reconstructive Arthroplasty Using Modular Segmental Endoprosthesis: A Case Report

Severe injury to the knee and the surrounding area is frequently associated with injury to ligaments of the knee joint and structures in the popliteal fossa. This case involved a popliteal artery occlusion, severe bone loss of distal femur, loss of collateral ligaments, and extensor mechanism destruction of the knee. Initially, prompt recognition and correction of associated popliteal artery injury are important for good results after treatment. After successful revascularization, treatment for severe bone loss of distal femur and injury of the knee joint must be followed. We treated this case by delayed reconstruction using modular segmental endoprosthesis after revascularization of the popliteal artery. This allowed early ambulation. At 36 months after surgery, the patient had good circulation of the lower limb and was ambulating independently.     

Significance of magnetic resonance imaging in the diagnosis of vertebral artery injury associated with blunt cervical spine trauma.

Vertebral artery injury associated with non-penetrating cervical trauma is rare. We report 11 cases of vertebral artery injury diagnosed with magnetic resonance imaging (MRI) after blunt trauma to the cervical spine and discuss about the importance of MRI in the diagnosis of this injury. Seven cases were caused by motor vehicle accidents, three by diving accidents, and one by static compression of the neck. All of the patients had documented cervical spine fractures and dislocations. In three patients, the diagnosis of complete occlusion of the vertebral artery was made on the basis of MRI and digital subtraction angiography (DSA). In the other patients, mural injuries of the vertebral artery were demonstrated with DSA. These 11 patients presented with acute, nonspecific changes in neurological status. Two had infarctions of the cerebellum and brainstem. None were treated with anticoagulants. All of them survived and were discharged to other hospitals for physical and occupational therapy. Although DSA remains the gold standard for diagnosing vertebral artery injuries, MRI is a newer modality for assessing cervical cord injury, and it may be useful for evaluating the presence of vertebral injury after blunt cervical spine trauma.     

Endovascular treatment of blunt injury of the extracranial internal carotid artery: the prospect and dilemma

The extracranial internal carotid artery (ICA) refers to the anatomic location that reaches from the common carotid artery proximally to the skull base distally. The extracranial ICA belongs to the C1 segment of the Bouthillier classification and is at considerable risk for injury. Currently, the understanding of endovascular treatment (EVT) for blunt injury of the extracranial ICA is limited, and a comprehensive review is therefore important. In this review, we found that extracranial ICA blunt injury should be identified in patients presenting after blunt trauma, including classical dissection, pseudoaneurysm, and stenosis/occlusion. Computed tomography angiography (CTA) is the first-line method for screening for extracranial ICA blunt injury, although digital subtraction angiography (DSA) remains the “gold standard” in imaging. Antithrombotic treatment is effective for stroke prevention. However, routine EVT in the form of stenting should be reserved for patients with prolonged neurological symptoms from arterial stenosis or considerably enlarged pseudoaneurysm. Endovascular repair is now emerging as a favored therapeutic option given its demonstrated safety and positive clinical and radiographic outcomes.     

闭合性胫骨平台骨折合并腘动脉损伤的手术疗效分析

目的探讨闭合性胫骨平台骨折合并腘动脉损伤的手术疗效。方法回顾分析2005年1月~2014年12月收治且获得随访的68例闭合性胫骨平台骨折合并腘动脉损伤患者资料,男52例,女16例,胫骨平台骨折按Schatzker分型:Ⅳ型13例,V型32例,Ⅵ型23例。腘动脉损伤程度分级:完全断裂10例,部分断裂36例,外膜完整内膜损伤22例。受伤至手术时机:受伤6小时以内实施手术49例,受伤6~24小时实施手术11例,受伤48~96小时实施手术8例。末次随访根据Rasmussen膝关节功能评分标准进行评价。结果 49例6小时以内行血管探查修复并骨折复位固定的患者中,38例血液循环稳定,8例出现迟发性肌肉坏死,经多次清创,创面愈合,3例出现静脉危象,保肢无效。19例6小时以后实施手术的患者中,5例血液循环稳定,5例小腿肌肉部分坏死,经清创、换药、二期植皮后创面愈合;9例术后36~48小时出现血循环障碍,经急诊探查,其中1例患者好转,其余8例患者术后循环未改善,后出现大量肌肉坏死高热、肾衰,最后行高位截肢。根据Rasmussen膝关节功能评价标准:优20例,良26例,可9例,差13例,优良率67.6%。按照膝关节功能评分,手术时机、固定方式以及是否预防减压均有统计学意义。结论闭合性胫骨平台骨折伴腘动脉损伤患者早期诊断并在6小时内实施手术是保肢成功的关键,外固定架固定及预防性小腿筋膜室切开减压可减少肌肉坏死和感染的发生,降低并发症,改善预后。     

膝关节脱位的早期诊断及微创治疗方法

目的　探讨膝关节脱位的早期诊断及微创治疗。 方法　回顾性分析2011年7月~2015年10月收治的90例创伤性膝关节脱位患者,一期行关节镜下韧带重建术,关节囊不予修复,腘动脉损伤修复后推迟3周进行韧带重建,若小腿肌肉已坏死,则取胫骨前肌肌腱或跟腱进行韧带重建,神经行探查、松解或缝合术,Lysholm膝关节评分来评价手术前、后膝关节功能。 结果　本组90例患者中,78例获得随访,平均随访时间为18个月（9~24个月）。末次随访膝关节功能Lysholm评分为78~91分,平均85.6分。前后抽屉试验I°阳性各75例,Lachman试验I°阳性75例,内外翻试验均阴性,3例腘动脉损伤导致小腿肌肉坏死者术后出现Ⅱ°松弛1例,Ⅲ°松弛2例。 结论　物理与影像学检查对判断创伤性膝关节脱位有积极意义,单纯一期膝关节多发韧带损伤重建的方法可行,近期疗效满意。     

Popliteal vessel trauma: Surgical approaches and the vessel-first strategy

Background

In this study, we analyzed long-term outcomes following treatment of traumatic popliteal vascular injuries in an urban level I trauma center, using a vessel-first approach in the case of combined vascular and bony/ligamentous injuries and discussing the relative merits of the medial and posterior approach to popliteal vessels.

Popliteal vascular entrapment syndrome caused by variant lateral head of the gastrocnemius muscle leading to pulmonary artery embolism

A young man with popliteal vascular entrapment syndrome (PVES) presented with arterial occlusion, deep venous thrombosis (DVT), pulmonary artery embolism, and pulmonary hypertension. He received computer tomography (CT) and magnetic resonance imaging (MRI). Both CT and MRI showed that the left thrombosed popliteal vein and artery were entrapped by a variant lateral head of the gastrocnemius muscle. The anomalous slip originated from the lateral head of left gastrocnemius muscle and ended between the medial and lateral femoral condyles. PVES Type V was diagnosed. Compression of the popliteal vein without arterial compression can be explained by the more lateral location of the popliteal vein relative to the artery and its proximity to the lateral head of the gastrocnemius. Compression of the popliteal vein with arterial compression was found in this patient. Compression of popliteal vein and artery in this patient led to DVT and arterial occlusion. The case was the first reported case accompanied by popliteal vein and artery thrombosis caused by variant lateral head of the gastrocnemius muscle. Radiologists and doctors should continue to look for possible abnormalities in the popliteal fossa in young patients with peripheral vascular disease because early diagnosis of PVES allows better choices and outcomes of treatment. Clin. Anat. 25:986–988, 2012. © 2012 Wiley Periodicals, Inc.     

Traumatic diaphragmatic hernia

A review of ten years of experience with traumatic diaphragmatic hernia, an often-missed injury, is presented. The unusual occurrence of a right diaphragmatic hernia following blunt trauma, which occurred in one patient, prompted this retrospective review. A high index of suspicion is still a safeguard against missing this injury. The mechanism of diaphragmatic tear with blunt trauma is described and modes of diagnosis and treatment are discussed.     

不同平面腘动脉损伤血清肌酸激酶动态变化的临床特点

目的　 探讨不同平面腘动脉损伤致患肢创伤严重程度的临床意义,评估腓肠动脉在腘动脉创伤修复中的作用。 方法　收集2010年1月~2019年12月收治的单侧膝关节周围骨折（含脱位）患者103例。其中,合并腘动脉损伤患者68例,根据损伤平面是否高于腓肠动脉分为高位组（16例）和低位组（52例）;其余35例为对照组。对比分析3组患者术前、术后1、3、7、15 d肌酸激酶（creatine kinase,CK）。 结果　高位组CK值显著大于低位组,低位组大于对照组（F=217.709,P<0.001）;同一时间点（术前、术后1、3、7、15 d）3组患者CK值两两比较均有明显差异（P<0.001)。高位组CK各时间点比较均有统计学差异（P<0.05）;低位组术前与术后7 d（P=0.930）、术后1 d与术后3 d（P=0.195）比较无统计学差异。 结论　高位组患肢缺血、损伤程度重于低位组;腓肠动脉是腘动脉不同损伤平面CK差异的主要原因,具有代偿作用。     

CT血管成像术在腘动脉陷迫综合征的应用

目的探讨CT血管成像术(CTA)在动脉陷迫综合征(PAES)诊断中的应用价值。方法回顾性分析8例经手术病理证实的PAES患者的CTA资料,其中4例行数字减影血管造影(DSA)检查。结果CTA图像可清晰显示8例患者动脉与周围组织之间的关系,均可见异常走行的腓肠肌内侧头及其肌腱或纤维组织束压迫动脉。CTA能清晰显示动脉狭窄闭塞的部位、范围、程度、侧枝循环形成情况及动脉与周围组织间的关系。结论CTA诊断PAES准确率100%,明确病因诊断优于DSA。