踝部环形绳索勒伤

目的探讨踝部环形绳索勒伤的特殊性和治疗方法,以减少截肢率,尽可能恢复患肢功能。方法踝部环形绳索勒伤患者9例,胫前(足背)、胫后动脉同时损伤7例,单一胫后动脉损伤2例。4例合并胫腓骨开放性骨折,2例合并胫腓骨闭合性骨折,外踝闭合性损伤2例。受伤至治疗时间为6~27h,平均12h,其中1例缺血时间达29h。均早期行血管神经探查吻合,骨折外固定。结果9例患者均保肢成功,患肢功能大部分恢复。1例有外踝畸形愈合,晚期行截骨矫形后治愈。结论应重视对踝部环形绳索勒伤患者的急诊处理,一旦确诊有血管神经损伤,应尽早行血管、神经探查吻合,合并骨折者应使用外固定稳定骨折断端。对皮肤环形损伤应尽早切开减压,避免“止血带”效应。对延迟就诊的患者,积极的保肢治疗可以取得良好的治疗效果。

The looped ankle injury caused by cord strangulation

Objective To investigate the characteristics of looped ankle injury caused by cord strangulation, seek proper treatment to decrease amputation rate, and restore limb function as much as possible. Methods Among the nine patients with looped strangulation ankle injury, 7 had both their anterior and posterior tibia arteries involved, while the other 2 patients had only their posterior tibial artery involved. There were 4 patinets suffered from combined open tibia and fibula fractures, 2 patients from close tibia and fibula fractures; and another 2 patients from external malleolus fracture. The interval from injury to treatment varied from 6 to 27 hours(average 12 hours). All patients were treated with surgical procedures as soon as possible, blood vesseles and nerve injuries were detected and anastomosis had been done if necessary. All fractures were fixed externally. Results The limbs of all 9 patients were salvaged successfully. Most function of the injured limbs were restored. Only one external malleolus fracture malunited and was treated successfully by subsequent osteotomy. Conclusion Emergent intervention is of great importance to looped ankle injury caused by cord strangulation. Once blood vessel or nerve injuries are suspected, surgical detection or anstomosis if neccessary, should be done as soon as possible. All the associated fractures should better be fixed externally, and in order to avoid "tourniquet effect"the injured skin should be incised as early as well. With proper limb salvage procedure, good or excellent result may be achieved even in the patient with a delayed diagnosis.