胫骨上段骨折并腘动脉分叉部闭合性损伤的临床观察

目的：探讨手术治疗胫骨上段骨折合并腘动脉特殊部位损伤的疗效,为临床提供可选择的显微手术方法。方法：2002年2月至2007年10月,胫骨上端骨折并腘动脉分叉处损伤患者19例,男15例,女4例;年龄21～48岁,平均35岁。合并胫骨平台骨折6例;合并神经损伤3例。采用外固定支架固定胫骨骨折,结合小腿近端后侧及前外侧切口对骨间膜开窗引洞,利用移植的大隐静脉（或＂Y＂形）桥接同时修复胫前及胫后动静脉。疗效评价依照Rasmussen评分法。结果：19例均恢复血运,骨折均愈合,愈合时间3～14个月,平均5.5个月。19例获得随访,随访时间8～23个月,平均13个月。疗效评价依照Rasmussen评分法,术后总评分达（27.0±2.9）分;疗效分级：优11例,良7例,可1例。结论：诊断明确后或高度怀疑有血管损伤者应该尽早手术探查。同时重建胫前、胫后动静脉血循环能够降低伤残并且有利于肢体功能恢复。

Clinical diagnosis and treatment of superior tibial fracture complicating with crotch injury of distal popliteal artery

Objective: To investigate the clinical effects of treatment for superior tibial fracture complicating with crotch injury of distal popliteal artery by an alternative micro-surgical operation. Methods: During Feb. 2002 to Oct. 2007,there were 19 patients with superior tibial fracture complicating with crotch injury of distal popliteal artery included 15 males and 4 females aged from 21 to 48 years(means 35 years). There were 6 cases complicating with fracture of tibial plateau,3 cases complicating with nerve injury. The tibial fracture were fixed with external fixator and the anterior tibial artery and vein and posterior tibial artery and vein were treated by transplantable great saphenous vein(Y-shape) combined with windowing for interosseous membrane by the posterior and anterolateral incision. Evaluations of clinical effect were performed according to Rasmussen functional score system. Results: All patients survived after operation. All fracture achieved bony union,the union time was from 3 to 14 months(means 5.5 months). All patients were followed-up for from 8 to 23 months(means 13 months). The mean Rasmussen functional score was(27.0±2.9). The results were excellent in 11 cases,good in 7,and fair in 1. Conclusion: The surgical exploration should be done as soon as possible when diagnosis of injuries of large arteries is definite or highly suspected. Simultaneous reconstruction of both posterior tibial artery and anterior tibial artery associated with vein can reduce the rate of disability and recover function of limb.