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.

Diagnosis and treatment of tibia-fibular fractures complicated with injury to a major artery

Objective To discuss the value of angiography by computed tomography (CTA) in the early diagnosis and treatment of tibia-fibular fractures complicated with injury to a major artery. Methods To assist the diagnosis of the tibia-fibular fractures complicated with suspected injury to a major artery,digital subtracted angiography (DSA) and Doppler were employed before 2006 in our hospital and CTA after 2006. Once the diagnosis had been confirmed,vascular repair was done by anastomosis,vein transplantation or synthetical vessel grafting depending on different conditions of the patient. Amputations were performed in case the limb had necrosed. Results CTA was accurate in the diagnosis of artery injury but its mean examination time of (42.0±9.5) min was significantly shorter than that of DSA [(2.5±0.6) h] and Doppler [(67±12) min]. Of the total 18 cases,12 were diagnosed early and thus had successful limb sal-vage,but the other 6 whose diagnosis had been delayed had to suffer from partial amputation (5 patients) and early-stage amputation at the thigh level (1 patient) . Conclusions Early diagnosis is a key factor of successful treatment for patients with tibia-fibular fractures plus major artery injury. CTA plays an important role in the early diagnosis of such cases.