四肢主要动脉损伤的临床治疗

目的：总结四肢主要动脉损伤的诊治经验。方法：1989—2000年68例四肢主要动脉损伤患者，分别采用断端吻合、血管修补、自体静脉移植、残端结扎等方式修复损伤血管。结果：随访2--11年，62例肢体存活，6例截肢，2例出现轻度缺血性肌挛缩。结论：早期诊断是肢体抢救成活的关键，损伤动脉应尽可能在6—8h内进行修复，根据不同的损伤类型，分别采用不同的血管修复方法。积极治疗多发伤、及时处理并发症。     

四肢动脉损伤诊治体会

目的探讨四肢动脉损伤的诊断和治疗方法。方法回顾分析我院1996年1月至2006年7月共诊治的23例四肢动脉损伤患者的临床资料。分别采用直接动脉修补、动脉结扎、端端吻合、自体大隐静脉移植及人工血管吻合。术中取栓6例,合并静脉损伤修复8例。结果截肢3例(13.0%)。获得随访12例,随访时间3个月～5年,11例多普勒超声证实损伤血管血流通畅,下肢肌肉挛缩1例;下肢血供不足1例。结论早期诊断是提高肢体存活率和避免假性动脉瘤发生的关键。手术方式的合理选择、Fogarty导管常规取栓和早期筋膜切开可提高治愈率。     

火器性四肢动脉伤：附50例报告

作者报告５０例５２条四肢火器性动脉伤，其中枪弹伤３７例，弹片伤１３例；急性动脉伤３２例（３３条），晚期动脉伤８例，假性动脉瘤７例，动静脉瘘３例（４条）。平均随访２４．２个月，无一例死亡，修复血管通畅率９３％，截肢率９．８％，肢体缺血性挛缩发生率１０．９％。作者强调，早期诊断、早期正确处理此类动脉伤是成功的关键。应争取在伤后６～１２小时内修复损伤血管。根据临床表现可作出诊断，急性动脉伤一般不做血管造影，对可疑肢体主要动脉伤应积极手术探查。根据伤情采用对端吻合或自体静脉移植修复血管，不主张用人造血管修复，血管部分断裂不宜做侧壁吻合。晚期动脉伤应争取修复血管以改善肢体循环。假性动脉瘤和动静脉瘘宜早期切除修复血管，待伤口愈合、组织柔软后即可手术。     

自体大隐静脉移植修复四肢主干动脉损伤

目的总结自体大隐静脉移植修复四肢主干动脉损伤经验。方法采用自体大隐静脉移植修复96例四肢主干动脉损伤患者。结果大隐静脉移植2～18 cm。96例肢体主干动脉损伤患者中,3例因合并其他重要脏器损害死亡,2例截肢,91例肢体保留。91例随访时间6个月～3年。91例肢体血液循环正常,84例功能恢复正常,5例遗留下肢跛行及髋部活动度下降等功能障碍,2例肘关节活动受限。结论早期诊断、及时手术对保存肢体至关重要。采用自体大隐静脉移植修复四肢主干动脉损伤手术方便,成本低,血管吻合通畅率高,治疗效果好,有助于降低截肢率。     

四肢主要动脉挫伤合并血栓形成12例

目的：探讨四肢主要动脉挫伤合并血栓形成的诊断和治疗方法。方法：对12例四肢主要动脉挫伤合并血栓形成患者,9例行血栓取出、动脉损伤段切除断端吻合术,3例行血栓取出、动脉损伤段切除自体大隐静脉移植术,7例血管修复后行骨筋膜室切开减张术。结果：12例中,8例肢体完全成活,术后恢复良好;1例术后小腿肌肉小部分坏死,遗留轻度跛行;3例截肢。结论：四肢主要动脉挫伤合并血栓形成,早期易漏诊,诊断明确应尽快行血管修复,恢复肢体血运。     

胫骨上端骨折合并腘动脉损伤

目的 :报道胫骨上端骨折合并动脉损伤的治疗效果。方法 :1993～ 1998年共收治胫骨上端骨折合并动脉损伤病人 12例 ,其中动脉断裂 8例、血管内膜损伤后血栓形成 1例、血管受压 3例 ,动脉断裂采用自体大隐静脉移植修复 6例、端端吻合 2例。结果 :1例因肢体缺血时间过长、坏死而截肢 ,血管吻合术后肢体存活率为 10 0 %。结论 :仔细的临床检查是发现肢体血管损伤的重要手段 ,早期诊断和及时合理的治疗是处理血管损伤的关键     

周围静脉损伤的治疗（附33例报告）

对我院近３０年收治的３３例周围静脉损伤患者的资料进行了分析总结。作者认为，周围静脉损伤在血管损伤中占有一定的比例，绝大部分静脉伤都伴有动脉伤；静脉高压是导致筋膜间综合征的重要因素，因此结扎或不修复损伤的主干静脉有可能导致筋膜间综合征；持续性暗红色的伤口出血、弥漫性皮下血肿、肢体肿胀及青紫是静脉损伤的特点；多普勒超声血管检查及静脉造影有助于诊断；对损伤静脉宜行静脉修复，其修复方法根据损伤类型而定，可作侧面修补、补片移植、端端吻合或自体静脉移植等；静脉重建后早期可能有血栓形成，但这一并发症可以预防。     

四肢主干血管损伤的诊治

目的探讨四肢主干血管损伤的早期诊断、治疗方法以及临床效果。方法2001年1月-2006年6月，收治72例四肢主干血管损伤患者。男50例，女22例；年龄5～60岁，中位年龄39岁。开放性损伤44例，闭合性损伤28例。动脉损伤部位：锁骨下动脉1例，股动脉23例，胭动脉20例，尺桡动脉同时损伤12例，肱动脉11例，腋动脉3例，胫前后动脉同时损伤2例。伤后至入院时间30min～27d。术中血管破口直接修补3例，端端吻合39例，自体大隐静脉移植修复30例，移植长度3～8cm。结果67例肢体成活，5例截肢。48例获6个月～5年随访，彩色多普勒血流仪检查血流速度及血管口径与健侧无明显差异。40例肢体功能恢复满意，8例残留不同程度功能障碍，其中4例行矫形或功能重建手术，功能及外形得到改善。结论了解损伤机制及受伤情况，认真体检，综合分析，是主干血管损伤早期诊断的关键；显微外科修复是提高血管通畅率的保障；术后筋膜间室综合征及肢体缺血时间超过4h的肱动脉、胭动脉以上的血管损伤，及时行筋膜间室切开是恢复肢体功能、避免伤残的有效手段。     

纵向生物力学特性对动脉损伤修复方法选择的影响

目的 研究人体四肢主要动脉不同长度损伤与修复方法选择之间的关系，比较由于因管纵向性物力学特性面产生的修复差异，为临床修复效果及近，远期疗效评价提供依据。方法 回顾分析应用端端吻合法和自体静脉移植法修复的四肢主要动脉伤共１７７例１８５条血管，对相同损伤部位而不同修复方法的血管的真性缺损长度做ｔ检验比较，通过９５％置信区间分析两种修复方法的选取界限。对自体静脉移植修复血管中真性缺损长度做ｔ移植长度做线     

四肢主要动脉损伤的诊治

目的探讨四肢主要动脉损伤的诊治方法。方法本组34例36条损伤的动脉，血管修补8条，对端吻合13条，自体静脉移植8条，手术解除骨折压迫1条，切升减张清除血栓4条，血管内液压注射解痉2条，结果所有患随访4～57个月，平均28个月，无死亡病例，肢体存活30例，截肢4例，1例腕关17离断，2例小腿离断，1例踝关节离断，随访肢体皆存活，功能恢复满意，结论早期诊断，及时手术，防治术后并发症是挽救生命、提高治愈率和降低肢体坏死率的关键。     

Treatment of limb arterial in juries caused by traffic accidents

Objective:To analyze the features,diagonosis and treatment of limb arterial injuries caused by traffic accidents.Methods:A total of 43 patients with limb arterial injury admitted in our department over the past 30years(about50%of them happened during the last10 years)were analyzed retrospectively in this article.The popliteal,femoral and brachial arteries were mainly involved,accounting for 432%,20.5%and20.5%respectively of all the involvements.There were 35cases of open injury and9of close injury,The involved vessels were transected in 43.2%of the cases and contused in 40.9%,All the patients had various complications,such as fractures,dislocations and severe soft tissue injuries.The injured vessels were repaired by means of end-to-end anastomosis in 10cases,autogenous vein graft in 23cases and intraluminal hydraulic dilatation in 4cases.Results:Successful limb salvage was achieved in 34cases initially,whereas10amputations were carried out due to injuries to popliteal arteries in7,femoral arteries in2and humeral artery in 1and severe soft tissue damages in9 cases.Twenty-nine patients were followed up for 1-156months,with the averageof48.8months.There was good circulation in 22 cases and certain ischemia in 5cases.Two amputations were carried out in the late stage because of popliteal artery thrombosis after repair in 2cases.There was no death in this series.Conclusions:The limb arterial injuries caused by traffic accidents are severe and complicated.It is proposed that particulatr attentions should be paid to the features in diagnosis and treatment for this type of injury and special efforts should be made for both life saving and limb salvage.     

War Injuries of Major Extremity Arteries

Abstract During the period 1991–1994, 99 patients (all males, median age 35 years) with combat-related injuries of major limb arteries were managed. Mechanism: mine fragments (40%), high-velocity projectiles (35%), and shotgun pellets (25%). Patients were admitted 1 hour to 16 hours (median 8 hours) after injury; 39% were in severe hemorrhagic shock. Arterial injury was diagnosed by clinical findings. Preoperative angiography was usually not necessary. Of 99 injured patients, 50 (51%) showed signs of distal ischemia and required arterial reconstruction. No primary amputation was performed. Reconstruction was always necessary in cases of injury of axillary or popliteal arteries, but not of superficial femoral or brachial arteries. Ligation of injured single forearm or crural arteries was well tolerated. End-to-end anastomosis by reconstruction was possible only in 38% of cases. In 56% of patients, autologous venous bypass was performed. Uncontrolled wound infection developed in 22% of cases, leading to a secondary hemorrhage compelling arterial ligature (8%), and thrombosis (6%). The secondary amputation rate after arterial reconstruction was 10%. Injury of major vessels was associated with limb bone fractures, nerve damage, or major vein injuries in 68% of cases, frequently on the forearm, the popliteal region, and the crural region. When limb ischemia was present, vascular reconstruction had priority over orthopedic immobilization. Arterial injury was almost always associated with the venous damage in the forearm, the popliteal region, and the crural region. Injured veins of the upper limb were ligated; venous repair was more often indicated in lower limb injury (52%). The method of choice was lateral suture/patch. Gunshot damage to peripheral nerves was rarely treated with primary repair.     

下肢主干血管损伤超时限修复与功能重建

[目的]探讨下肢主干血管损伤后超时限修复及其功能重建,并观察临床疗效。[方法]回顾性研究收治的30例下肢主干血管超时限修复患者,男21例,女9例,年龄13~55岁,平均(34.17±9.40)岁。其中股动脉13例,包括开放性3例,闭合性10例;腘动脉17例,包括开放性6例,闭合性11例。[结果]30例患者中,直接吻合者22例,行对侧大隐静脉移植者7例,1例肢体短缩后吻合。损伤至血流再通时间10~72 h,平均(41.07±19.32)h;27例患者术后肢体血运良好,2例截肢,1例因大出血,给予结扎血管,肢体虽然存活,但末端血运差。30例患者最终截肢2例,截肢率6.67%。28例保肢功能者随访24~60个月,平均(41.25±10.45)个月。11例患者出现继发性足下垂畸形,再次手术,行Ilizarov踝支架矫正畸形。末次随访时,28例患者足底感觉、足背伸肌力、足背伸-跖屈ROM、膝伸-屈ROM和VAS评分均较术后1个月时显著改善,差异均有统计学意义(P<0.05)。28例患者开始行走时间20~240 d,平均(75.25±55.35)d,完全负重时间30~400 d,平均(148.57±90.02)d。[结论]对超时限主干血管损伤,经积极手术,术后综合治疗,仍可获得较满意临床效果。     

上肢热压伤合并主干血管损伤的治疗

目的探寻肢体热压伤合并主干血管损伤的治疗方案。方法对8例上肢严重热压伤合并骨筋膜室综合征患者实施减压术，但对肢体血运的改善不明显。行血管探查得知患肢均合并肱、桡、尺动脉或掌深、浅弓损伤，采用直接吻合、屈曲肢体吻合、大隐静脉移植等方式修复血管并移植中厚皮片或带蒂胸脐皮瓣封闭创面。结果l例肱动脉修复后创面植中厚皮片者因无良好的软组织覆盖，术后4周血管再度栓塞导致上臂中段截肢。7例血管修复后创面移植皮瓣的患者肢体血供完全恢复并得以完整保留。结论及时行血管探查和修复以及选择周围良好的软组织覆盖，是治疗热压伤合并主干血管损伤的关键措施。     

The continuing challenge of popliteal vascular injuries

During a 6 year period, 35 patients with 56 popliteal vascular injuries were treated. Thirty-three arteries and 23 popliteal veins were affected. Fifty-four percent of the patients had both an arterial and a venous injury. Twenty injuries were due to penetrating trauma and 15 injuries to blunt force. An overall amputation rate of 16 percent followed attempts at vascular repair. Blunt injuries were associated with a 30 percent amputation rate, whereas penetrating injuries were associated with only a 5 percent amputation rate. When our results were reviewed and compared with those of others, several factors important for determining the rate of limb salvage in popliteal vascular injuries were noted: (1) early recognition and prompt treatment, (2) absence of blunt injury with attendant soft tissue damage; (3) resection of damaged arterial tissue with end-to-end anastomosis or saphenous vein grafting in conjunction with the liberal employment of local heparin and a Fogarty catheter thrombectomy, (4) repair of concomitant popliteal venous injuries; (5) use of completion arteriography to reveal technical errors amenable to correction at time of operation; and (6) fasciotomy, used liberally but selectively.     

Arterial injuries. Review of 12 years experience with 32 patients.

Thirty-two patients with 41 injured arteries were operated upon during a period of 12 years. Three quarters were men, and the median age was 33 years. Accompanying lesions were seen in 87.5% of the patients. Nearly half the lesions were related to blunt trauma. Occupational accidents constituted the largest group. The diagnosis was made on clinical grounds in most cases. The median time lapse from trauma to operation was 5 hours. The principles of treatment were those that are generally accepted. No patients died, the amputation rate was 12.5%. Median follow-up was 8 months. A successful arterial reconstruction contributed to a good functional result. Postreconstruction thrombosis of arteries were found to occur within the first hours or days after reconstruction. Late thrombosis was rare and the overall long-time patency was 61.4%. Patency of repair of upper limb small vessels was 54.5%.     

四肢主要动脉损伤的急诊显微外科修复56例

目的 探讨四肢主要动脉损伤的早期诊断及急诊显微外科修复的临床疗效。方法 对我科在1995年2月至2006年4月应用显微外科技术修复四肢主要动脉损伤56例的临床资料进行回顾性分析。结果 治愈51例，截肢3例，主要原因是肢体的严重创伤或严重感染。死亡2例，主要原因均为严重颅脑外伤。本组51例均获随访，随访6个月～2年，患肢血运及功能良好，超声多普勒检查未见异常。结论 对周围主要血管损伤的应尽早诊断，应用显微外科技术进行急诊手术，尽快控制出血和恢复肢体血运，有助于提高治愈率和功能恢复。     

Apparently severe arterial hypertension: limitations of sphygmomanometry

Mönckeberg's sclerosis is characterized by medial arterial calcifications. This disease usually occurs in old people and the lesions are observed in distal lower limb arteries. The evolution is generally asymptomatic. The other arteries are uncommonly affected. This report concerns a patient with exceptionally extensive disease and simultaneous asymptomatic arterial hypertension. Blood pressure measured non invasively represents the force required to compress the brachial artery, and not the real blood pressure. In such patients, blood pressure should be monitored during anaesthesia through arterial cannulation.     

胫腓骨骨折合并下肢主要动脉损伤的诊治

目的 探讨胫腓骨骨折合并下肢主要动脉损伤的诊治,并关注64排CT血管造影(CTA)在其早期诊断中的作用.方法 回顾性分析2000年1月至2008年10月收治的创伤性胫腓骨骨折并怀疑合并下肢主要动脉损伤患者的救治过程,2006年前采用数字减影血管成像术(2例)和彩色多普勒超声(9例)辅助诊断,2006年后采用CTA辅助诊断(7例).一旦确诊,根据不同情况行损伤血管直接吻合、静脉移植或人工血管修复血管,肢体已经坏死者行截肢术.结果 CTA平均检查时间为(42.0±9.5)min,少于数字减影血管成像术的(2.5±0.6)h和彩色多普勒超声的(67±12)min,且准确率高.18例患者中12例得到早期诊断者无肢体功能障碍,6例延迟诊断者5例行部分截肢(趾)手术,1例一期行大腿截肢.结论 早期诊断是胫腓骨骨折合并下肢主要动脉损伤患者救治能否成功的重要因素,CTA在其早期诊断中具有很高的应用价值.     

125例急性下肢动脉创伤的诊治经验

目的探讨急性下肢动脉损伤的诊断和治疗方法。方法分析1988年1月至2004年2月手术治疗的125例急性下肢动脉损伤患者的临床资料。其中钝性伤56例、锐性伤66例、枪弹伤3例。伴有骨折36例,神经损伤11例,深静脉损伤23例。手术方法包括动脉修补(补片)28例、端-端吻合37例、自体静脉转流32例、人工血管转流23例、单纯取栓2例和单纯结扎3例。结果治愈率85·6%,生存率98·4%。1例死于术后多脏器功能衰竭,1例因失血休克死亡。截肢(趾)率10·4%(13/125),其中8例就诊时已有肢体坏疽。结论下肢动脉创伤有很高的截肢率。多普勒检查有助于早期诊断,对于创伤的患者如果踝/肱比小于1则提示可能有动脉损伤。适当的选择术式和早期筋膜切开,是降低截肢率和死亡率的关键。