腘动脉陷迫综合征23例

目的:分析23例腘动脉陷迫综合征(PAES)的临床资料,总结PAES影像学诊断与手术治疗的经验。方法:23例(26条下肢)PAES患者,男19例,女4例,年龄5～64岁,平均(31.2±14.4)岁。患者术前施行了超声多普勒,CTA或MR检查,并对25条患肢施行了相应的手术治疗,监测手术前后患肢踝肱指数(ABI)变化。20条患肢施行了腘动脉周围异常组织松解术,其中9条因动脉闭塞同时施行了大隐静脉旁路移植术,7条患肢因动脉内膜增厚实行腘动脉内膜切除加动脉成形术;5条肢体行自体大隐静脉移植术。结果:22例患者随访6月～6年,平均(30.09±17.92)个月,25条手术肢体间歇性跛行症状治愈,踝肱指数由术前的0.44±0.09上升至术后的0.92±0.10(P<0.01)。1例患者因肺动脉栓塞术后1 d死亡。结论:PAES是慢性下肢动脉缺血的一个病因,影像学诊断是确诊本病的重要手段,早期积极外科干预预后较好。     

腘动脉陷迫综合征的诊断和治疗

目的总结腘动脉陷迫综合征(PAES)的诊断治疗经验,探讨临床最佳诊断治疗方案。方法回顾性分析中国医科大学附属第一医院2000年1月至2008年1月诊治的8例PAES病例的临床表现、诊断方法、治疗方案和随访结果,总结诊断和治疗经验。结果8例PAES病人均应用CT血管成像术(CTA)检查得到早期诊断,并经手术病理确诊。均行肌肉分离术和(或)自体静脉移植动脉重建术治疗,手术治疗均获得成功。术后随访效果均良好。结论CTA检查是明确PAES诊断的较好方法。手术是治疗PAES的有效方法。病人的症状、腘动脉狭窄程度以及血栓形成等因素是决定手术治疗方案的要点。     

腘动脉陷迫综合征一例

患者男 ,14岁 ,既往体健 ,无外伤史。因每跑步约 10 0m即出现左小腿疼痛致使运动被迫停止 4 0d ,于 2 0 0 0年 5月10日入院。体检 :左膝关节周围皮温高 ,呈热膝 ,左足背、胫后动脉搏动明显减弱。数字减影血管造影 (DSA) :左腘动脉内偏并中段闭塞 ,近段端呈杯口状 (图 1) ,由膝上内、上外动脉、膝中动脉等与远段腘动脉沟通 (交通支形成 ) ,胫前、胫后动脉等分支正常 ,但流速较慢 (图 2 )。择期在持硬膜外麻醉下行左腘窝探查 ,术中见腘动脉内偏 ,被腓肠肌内侧头紧压于股骨内侧髁上 ,已僵硬 ,成条索状 ,管壁增厚 ,内膜增生 ,下段狭窄 ,上段血…     

腘动脉陷迫综合征的诊断与治疗

胭动脉陷迫综合征（popliteal artery entrapment syndrome,PAES）是指胴动脉与其周围肌肉或肌腱、纤维组织束的位置先天性关系异常所导致胭动脉受压而引起的下肢缺血症状群。临床虽为少见,但在青少年．特别是男性青少年下肢缺血的鉴别诊断中不容忽视。本文总结PAES的诊断与治疗要点,以求提高对该征的认识,避免延误诊治。     

腘动脉陷迫综合征的影像学诊断与手术治疗

目的 总结腘动脉陷迫综合征(popliteal artery entrapment syndrome,PAES)的影像学诊断与手术治疗经验.方法 本组11例(13条下肢)PAES患者,经CTA和MR(A)等检查确诊.其中男8例,女3例,平均年龄(28±19)岁;2例累计双下肢.间歇性跛行是最主要的症状.12条肢体术前踝肱指数(ankle brachial index,ABI)平均为0.47±0.27.结果 影像学结果 证实:6条患肢为Ⅰ型,3条患肢为Ⅱ型,3条患肢为Ⅲ型,另外1条患肢为Ⅳ型.11例患者中12条患肢接受了腘动脉探查或周围组织松解术,其中7条因动脉闭塞或动脉瘤同时施行了大隐静脉旁路移植术.本组随访11例(12条患肢),随访时间0个月至6年,平均(19 ±20)个月.术后平均ABI为0.81±0.30,较术前显著提高(P＜0.05),其中1例患者术后第1天死于肺栓塞,1例患者(1条患肢)术后腘动脉血栓形成,其他手术肢体间歇性跛行症状治愈.结论 腘动脉陷迫综合征的早期确切的影像学诊断和及时的外科治疗是至关重要的.

Abstract：

Objective To summarize the experience on imaging diagnosis and surgical treatment for popliteal artery entrapment syndrome (PAES). Methods From 2004 to 2010, 11 patients (12 limbs) diagnosed as PAES by CTA and MR ( A) underwent surgery. There were 11 patients with a mean age of (28 ±19) years, eight patients were male, three patients were female. Two patients were found to have bilateral involvement. Intermittent claudication was the most frequent presenting symptom. Six limbs were type Ⅰ , three limbs were type Ⅱ , three limbs were type Ⅲ , one limb was type Ⅳ. The preoperative mean ABI was 0.47 ± 0. 27. Results Popliteal artery exploration surgery or peripopliteal artery lysis was performed in 12 limbs, and this procedure was combined with a great saphenous vein bypass graft in seven limb because of arterial occlusion or aneurysm. After a median follow-up of ( 19 ± 20) months (0 month to 6 years) , the mean ABI improved to 0. 81 ±0. 30, which was significantly higher than that of preoperation( P ＜ 0.05),one patient died of pulmonary embolism one day after operation, one patient (one limb) had popliteal artery thrombosis after operation. Intermittent claudication symptoms disappeared in all other patients. Conclusions Timely imaging diagnosis and surgical intervention is very important for patients of PAES.     

CTA诊断腘动脉陷迫综合征的价值(附五例报告)

腘动脉陷迫综合征(popliteal arteryentraom entsyndrome,PAES)是一种少见的血管外科疾病。收集5例手术病理确诊PAES,其CT血管成像术(CT an-giography,CTA)表现及其诊断结果,报道如下。     

腘动脉陷迫综合征诊治的研究进展

腘动脉陷迫综合征(PAES)是腘动脉受周围肌肉、肌腱或纤维束反复挤压,引起的下肢缺血性疾病.PAES是相对少见的下肢血管病变,好发于下肢肌肉发达患者,尤其以青少年常见,早期缺乏典型症状,容易出现误诊及漏诊,PAES作为进展性疾病,晚期可发生严重不可逆的血管并发症.本文从PAES病理分型、辅助检查、治疗及预后等方面综合国...     

青少年腘动脉陷迫综合征17例诊疗分析

目的 总结青少年腘动脉陷迫综合征（popliteal artery entrapment syndrome,PAES）的影像学诊断与手术治疗经验.方法 对17 例（18 条下肢）青少年PAES 患者术前施行了超声多普勒,CTA或MR检查,并对17条患肢施行了相应的手术治疗,监测手术前后患肢踝肱指数（ankle brachial index,ABI）变化.13 条患肢施行了腘动脉周围异常组织松解术,其中5条因动脉闭塞同时施行了大隐静脉旁路移植术,4条患肢因动脉内膜增厚实行腘动脉内膜切除＋动脉成形术;4条肢体行自体大隐静脉移植术.结果 16例患者随访 6个月～6年,平均（30.88±19.88）个月,所有手术肢体间歇性跛行症状治愈,踝肱指数由术前的（0.47±0.09）上升至术后的（0.96±0.07）,较术前显著提高（P＜0.01）.1例患者因肺动脉栓塞术后1d死亡.结论 PAES是青少年下肢动脉缺血的一个重要病因.影像学诊断是确诊本病的重要手段,早期积极外科干预预后较好.     

功能性腘动脉陷迫综合征的CTA解剖特点初探

目的运用CTA标线法探讨功能性腘动脉陷迫综合征(functional popliteal artery entrapment syndromef,PAES)是否存在"解剖畸形"。方法 2007～2011年手术确诊的14条fPAES患肢与180条对照肢体的CTA进行比较,并用CTA标线法分析腘窝轴位上两组的解剖位置差异。结果 fPAES组所有患肢腓肠肌内侧头向外移位且13条(93%)向外超过了腘动脉,所有腘动脉均向深方移位;对照组腓肠肌内侧头完全起自"股骨内侧髁后上方"(解剖学所描述的标准位置)的仅占12%(21/180);对照组21%(38/180)腓肠肌内侧头与腘动脉相对位置关系及38%(68/180)的腘动脉深浅位置关系不符合标准解剖。结论腓肠肌内侧头的外移普遍存在,解剖"移位"可能从量变到质变f,PAES可能是严重移位导致的结果。内侧头外移超越腘动脉及腘动脉向深方移位是fPAES两个有意义的观察指标。     

腘动脉陷迫综合征外科治疗疗效分析

目的探讨外科治疗腘动脉陷迫综合征(popliteal artery entrapment syndrome,PAES)的疗效。方法回顾分析2006年4月-2014年4月收治的14例PAES患者临床资料,其中男13例,女1例;年龄20~54岁,平均35.5岁。左侧4例,右侧9例,双侧1例。10条患肢足背动脉搏动消失,5条患肢足背动脉搏动减弱;踝肱指数0.51±0.07。病程2周~12个月,平均5.2个月。根据PAES不同诊断及分型对9例患者行腘动脉周围异常组织松解术及腔内治疗术,余5例腘动脉功能性陷迫行保守治疗。结果 1例行肌切除、闭塞动脉取栓动脉成形术者,术后5 d腘动脉再次闭塞,行插管溶栓术后再通。其余患者经手术治疗及保守治疗后踝肱指数上升至0.93±0.22,与术前比较差异有统计学意义(t=5.634,P=0.000),跛行症状均缓解。14例均获随访,随访时间5~81个月,平均29.7个月。8例行腘动脉松解术后下肢活动正常,腘动脉血流通畅;1例介入下行球囊扩张术后11个月腘动脉再狭窄,给予抗血小板、抗凝保守治疗后症状未见反复。5例保守治疗患者治疗后下肢活动正常,腘动脉血流通畅。结论 PAES患者早期确诊并及时外科干预能获较好近、中期临床疗效。     

Functional Popliteal Entrapment Syndrome in the Sportsperson

Objective

To define the clinical syndrome of functional popliteal entrapment comparing pre and post surgical clinical outcomes with pre and post-operative provocative ultrasonic investigations. Further, to suggest a management pathway to differentiate chronic exertional compartment syndromes and concomitant venous popliteal compression.

Methods

In 32 claudicant sportspersons, 55 limbs were characterised pre-surgery clinically, with provocative testing including hopping, and following a series of non-invasive tests. The clinical findings, ankle brachial indices (ABI) and duplex outcomes were compared pre-operatively, at 3 months post-operatively (n = 52) and in the long term i.e. 16 months (n = 17).

Results

At 3 months, all 55 limbs had clinical follow up. 52 of the 55 limbs had follow up with ultrasound with provocative manoeuvres. The ABIs normalised in 46 (88%). There were 40 of 52 (76%) that became asymptomatic post surgery with a normal scan. There were 4 of 52 (8%) who were clinically asymptomatic but with residual obstruction on duplex and who were able to resume their usual lifestyle. There were 4 (8%) that had abnormal findings both on post-operative scan and clinically. Re-operation on 2 limbs corrected the duplex findings and the symptoms. There were 4 (8%) limbs that had normal duplexes but continued with symptoms albeit varied from the presenting symptoms. In the longer term, a further 2 became symptomatic at 2.8 years requiring a further successful intervention. (Concomitant popliteal venous obstruction was present in 5 limbs (10%) on standing.)

Conclusions

In the claudicating sportsperson, where there are no well characterised specific anatomical abnormalities, the syndrome can be characterised by provocative clinical (particularly hopping) and non-invasive tests. A positive clinical outcome with surgery can be predicted by abnormal pre-surgical ultrasonic investigations and confirmed later by a similar normal post surgical study. Concomitant venous compression may occur while standing with both syndromes related to muscle hypertrophy.     

Popliteal Artery Pseudoaneurysm After Arthroscopic Cystectomy of a Popliteal Cyst

A case of popliteal artery aneurysm after arthroscopic cystectomy of a popliteal cyst is an uncommon complication, and no case has been reported. We present a case of pseudoaneurysm of the popliteal artery after arthroscopic cystectomy of a popliteal cyst 2 months after surgery. Open excision of the pseudoaneurysm and popliteal artery pin-point repair were done. At 30 months' follow-up, both the tibialis posterior and dorsalis pedis pulsations were felt equally on both sides with normal sensations over the limb. Retrospectively reviewing the case, we found that the relation of the popliteal artery and popliteal cyst on preoperative magnetic resonance images can predict the complication of pseudoaneurysm of the popliteal artery. It is better not to shave the lateral aspect of the cyst while performing arthroscopic cystectomy when magnetic resonance images show that the popliteal artery is close to the cyst.     

腘动脉下段分叉部损伤的早期修复

文章报告了9例腘动脉下段分叉部损伤的治疗结果。除1例为土枪霰弹伤外,其余均为钝性暴力所致。早期截肢2例,后期截肢1例,截肢率33.3％。存活肢体中1例明显小腿缺血性挛缩,1例轻度小腿缺血性挛缩,4例功能基本正常。腘动脉下段分叉部损伤具有血管损伤范围广,远端缺血严重,常伴有骨、关节及皮肤、肌肉、神经等组织损伤等特点。尽早手术,同时重建胫前、胫后动脉血循环,尽量修复及保护伤肢静脉,常规行小腿深筋膜切开减压,骨折、脱位同时予以修复并可靠固定是提高治疗效果的必要措施。     

Cystic Adventitial Disease of the Popliteal Artery: Report of a Case

The etiology of cystic adventitial disease is unknown and the optimal treatment modality remains to be elucidated. We report a 58-year-old man diagnosed to have cystic adventitial disease in the popliteal artery, who was treated by a resection of the diseased segment of the arteries and then underwent reconstruction with a reversed saphenous vein graft interposition.     

Cystic Adventitial Disease of the Popliteal Artery: Elongation into the Media of the Popliteal Artery and Communication with the Knee Joint Capsule: Report of a Case

Cystic disease of the popliteal artery is a rare disorder in which most cases involve the formation of an adventitial cyst that disturbs the popliteal artery blood flow. We present herein the case of a patient presenting with popliteal artery occlusion due to compression by a cyst which formed at the media of the popliteal artery. The onset occurred during a baseball game in which he played catcher. Preoperative magnetic resonance imaging demonstrated a communication of the cyst with the adjacent knee joint. This unusual case could provide important clues to help identify the pathogenesis of this disease. Received: November 26, 1999 / Accepted: May 30, 2000     

Surgical treatment for acute ischemia caused by bilateral popliteal artery entrapment syndrome in an elderly patient: report of a case

We report the unusual case of a 73-year-old man who underwent surgery for bilateral popliteal artery entrapment syndrome (PAES). A medial approach was used to operate on the left leg, and the vein bypass was made from the superficial femoral artery to the crural artery through a subfascial route. A posterior approach was used to operate on the right leg and it was found that the mid-popliteal artery passed medial to and beneath the medial head of the gastrocnemius muscle and was severely compressed by an accessory slip of muscle. The vein bypass from the above-knee to below-knee popliteal artery was established through the original route after resection of the accessory slip of muscle. A postoperative arteriogram showed good bypass flow to the bilateral crural arteries. To our knowledge, this case represents the oldest patient with this disorder to be treated by surgery. Received: January 7, 2002 / Accepted: May 7, 2002 Reprint requests to: T. Sugimoto     

肩胛上神经卡压综合征的应用解剖学研究

对30具正常成人尸体的肩胛上神经及其相关结构进行了详细的观测。23.33±5.46％(14例)的肩胛上神经被结缔组织包裹,并固定于肩胛上孔中。孔中肩胛上神经多为扁圆形(89.50±4.2％),其宽径为3.3±0.87mm。肩胛上神经关节支多在肩胛上孔前方发出(83.33±4.81％),其中有2例发出皮支分布于臂上外侧部皮肤。对肩胛上神经在肩胛上孔内的位置做了三维定位,并讨论了肩胛上神经综合征的有关病因及临床应用要点。