35例腘动脉损伤的治疗体会

[目的]探讨腘动脉损伤的诊断及处理原则。[方法]对于35例腘动脉损伤病人，30例行腘动脉Ⅰ期修复，合并腘静脉及神经损伤的同时处理，损伤至动脉通血6h以上给予小腿筋膜室切开，检查渗出液性质，电刺激了解肌肉收缩情况。[结果]受伤至动脉通血6h以内及6h以上给予小腿筋膜室切开电刺激肌肉收缩良好，组织水肿渗出较轻，术后恢复满意；电刺激肌肉收缩差，组织水肿重，但渗出液较清淡，部分发生缺血性肌挛缩，肌肉发暗，电刺激无反应，并有血性渗出5例，3例Ⅰ期截肢，2例Ⅱ期截肢；2例因外院转来时皮肤已部分坏死，并发肾功能不全行Ⅰ期截肢。[结论]仔细的临床检查是早期诊断肢体血管损伤的重要手段，及时恢复循环是保肢关键，6h以上小腿筋膜室切开，不仅可以预防小腿筋膜室综合征的发生，而且通过电刺激肌肉收缩情况及组织水肿渗出情况，可以对预后给予判断，肌肉发暗，刺激无反应，并且有血性渗出，腘动脉修复价值不大，应该截肢。

The experience in treatment of thirty-five cases of popliteai artery trauma

[Objective ] To study the diagnosis and therapy principle of popliteal artery trauma. [ Method ] Thirty-five patients with popliteal artery trauma were included in this paper. Primary repair was done in thirty cases. The injury accompanying popliteal vein and nerve were repaired at the same time. Crural fascia compartment incisions had been done in the patients whose time of revascularization of the leg was more than six hours, and muscle contraction had been examined through electric stimulation.[Result] Satisfactory functions were achieved in the cases with good muscle contraction and less tissue edema after crural fascia compartment incisions. Amputation had been done in five cases with more severely tissue edema, part ischemia muscular contracture in the legs, and blood exudation; among them, three cases were given amputation at one stage, two cases were given amputation at two stages. Two cases from other hospital with part skin necrosis, and renal inadequacy were given amputation at one stage. [ Conclusign] Careful clinical examination is a key early diagnosis method; prompt revascularization is key measure to maintain limbs. As to the patient whose time of the revascularization is more than six hours, crural fascia compartment incisions should be done, that may not only prevent crural fascia compartment syndrome, but also help observe tissue edema, and muscle contracture by electric stimulation. Amputation should be done as to the patient with severe tissue edema and blood exudation, and with no muscle contracture by electric stimulation.