膝关节周围创伤伴腘窝血管伤的早期诊断与救治

目的 :探讨膝关节周围创伤伴腘窝血管伤的早期诊断与救治。方法 :回顾性分析2007年1月至2013年1月15例膝关节周围骨折、脱位伴腘窝血管损伤患者的临床资料,其中男9例,女6例;年龄26~62岁,平均39.2岁。结合临床症状、体征,运用血氧饱和度监测仪、彩色超声、DSA介入造影及手术探查等方法明确血管损伤,分别采用组合式外固定支架、钢板螺钉股骨髁逆行交锁钉内固定骨折及膝关节脱位,并根据具体情况对损伤血管进行取栓、修补、自体静脉移植重建血循环,分析手术时间、住院天数、保肢指数、输血量、医疗费用及感染发生情况,明确早期诊断及有效救治的作用。结果:本组患者死亡1例,截肢8例,6例手术成功修复腘动脉、胫前及胫后动脉。6例肢体存活患者随访12~60个月,平均28.3个月。保肢成功且关节功能优良4例。结论:膝关节周围创伤伴腘窝血管伤具有伤情复杂且严重、易误漏诊、预后差、保肢风险高等特点,应结合患者的创伤机制、损伤部位局部解剖特点、临床表现及适当的辅助检查来把握膝关节周围创伤伴腘窝血管伤的早期诊断,掌握合适的保肢与截肢指征以高效救治患者。

Early diagnosis and treatment for trauma around the knee with popliteal vascular injury

Objective:To investigate the early diagnosis and treatment for trauma around the knee with popliteal vascular injury. Methods:A retrospective analysis was employed to analyze the clinical data from 15 patients (9 males and 6 females were with a mean age of 39.2 years old,ranging from 26 to 62 years old) with fracture or dislocation around the knee with popliteal vascular injury from January 2007 to January 2013. Combined with clinical symptoms and signs,oxygen saturation monitors,color ultrasound,DSA angiography and interventional surgery were used to determine the vascular injury. The knee fracture and dislocation were fixed with hybrid external fixation and plate-screw fixation,respectively. Then,the blood circulation was reconstructed by thrombectomy,repair and autologous vein graft for individual injured vascular. The average total operation time,average hospitalization days,predictive salvage index (PSI),average blood transfusion amount,average medical expenses and infection cases were recorded to determine the effect of early diagnosis and treatment. Results:There was one patient with death,8 patients with amputation,and 6 patients with successful repair surgery for popliteal artery,anterior tibial and posterior tibial arteries. These six patients with surviving limbs were followed up for an average of 28.3 months (ranged,12 to 60 months). Among the 6 successful patients,the joint function of 4 patients was good and excellent. Conclusion:The trauma around the knee with popliteal vascular injury is characterized by complex and serious injury,easy misdiagnosis and loss diagnosis,poor prognosis and high risk of amputation. The early diagnosis of trauma around the knee with popliteal vascular injury should depend on the mechanism of trauma,local anatomical characteristics of injury site,clinical presentations and appropriate auxiliary examinations. The appropriate indications for limb salvage and amputation should be used to achieve more effective clinical results.