下肢主干血管损伤超时限修复与功能重建

目的]探讨下肢主干血管损伤后超时限修复及其功能重建,并观察临床疗效。方法]回顾性研究收治的30例下肢主干血管超时限修复患者,男21例,女9例,年龄13~55岁,平均(34.17±9.40)岁。其中股动脉13例,包括开放性3例,闭合性10例;腘动脉17例,包括开放性6例,闭合性11例。结果]30例患者中,直接吻合者22例,行对侧大隐静脉移植者7例,1例肢体短缩后吻合。损伤至血流再通时间10~72 h,平均(41.07±19.32)h;27例患者术后肢体血运良好,2例截肢,1例因大出血,给予结扎血管,肢体虽然存活,但末端血运差。30例患者最终截肢2例,截肢率6.67%。28例保肢功能者随访24~60个月,平均(41.25±10.45)个月。11例患者出现继发性足下垂畸形,再次手术,行Ilizarov踝支架矫正畸形。末次随访时,28例患者足底感觉、足背伸肌力、足背伸-跖屈ROM、膝伸-屈ROM和VAS评分均较术后1个月时显著改善,差异均有统计学意义(P<0.05)。28例患者开始行走时间20~240 d,平均(75.25±55.35)d,完全负重时间30~400 d,平均(148.57±90.02)d。结论]对超时限主干血管损伤,经积极手术,术后综合治疗,仍可获得较满意临床效果。

Delayed vascular repair and secondary reconstructions for major artery injuries of lower extremities

Objective]To explore the clinical outcome of delayed vascular repair,followed by secondary reconstructions for major artery injuries of lower extremities.Methods]A retrospective study was conducted on 30 patients who suffered from major artery injuries of lower extremities beyond optimal surgical timing.The patients included 21 males and 9 females aged13~55 years with a mean of(34.17±9.40)years,involving femoral arteries in 13 patients with open injury in 3 cases and closed injury in 10 cases,additionally,popliteal arteries in 17 patients with open injury in 6 cases and closed injury in 11 cases.Results]Of the 30 patients,22 patients underwent direct vascular anastomosis,7 patients had venous grafting with contralateral greater saphenous vein,and 1 patient received vascular anastomosis after bone shortening.The time interval from injuries to blood reperfusion ranged from 10 to 72 hours,with an average of(41.07±19.32)hours.Of them,27 patients kept proper blood perfusion at the limb terminals after operation,whereas 2 patients had the limbs amputated at 4 days after operation due to poor blood supply in 1 patient,and infection in another,on the other hand,1 patients had anastomosed artery ligated due to massive hemorrhage and got the limb alive regardless of suboptimal terminal perfusion.The amputation rate of this group of patients was of 6.67%.The 28 patients with successful limb salvage were followed up for 24~60 months,with a mean of(41.25±10.45)months.Among them,11 patients received the secondary surgical correction with Ilizarov technique for secondary foot drop deformities,and recovered well.To the latest follow up,the plantar sensation,dorsal flexion strength,ankle dorsal-plantar range of motion,knee extension-flexion and visual analogue scale for pain significantly improved compared with those at 1 month postoperatively(P<0.05).The time of beginning ambulation was 20~240 days with a mean of(75.25±55.35)days,while the time of complete weight bearing ambulation was of 30~400 days with a mean of(148.57±90.02)days.Conclusion]This delayed vascular repair,followed by secondary reconstructions does still achieve satisfactory clinical outcomes for major artery injuries of lower extremities beyond optimal surgical timing,if proper indication selected,and comprehensive evaluation and treatment given.