浮膝合并血管神经损伤的救治分析

目的 探讨浮膝合并血管神经损伤的临床救治特点。方法 收治浮膝合并血管神经损伤15例，骨折按张伯勋分类方法分成3型：Ⅰ型7例，Ⅱ型4例，Ⅲ型4例，分别采用交锁髓内钉、钢板和外固定架固定。血管神经损伤包括：股动静脉4例，腘动静脉4例 ，腘动静脉6例，胫前、胫后动脉同时损伤2例；坐骨神经损伤5例，胫神经2例，腓总神经3例；血管神经同时损伤8例。血管损伤采用血管端-端吻合、静脉移植桥接、血管修补或解除血管压迫。神经损伤采用神经松解、端-端吻合、神经移植。结果 15例中，合并脏器损伤死亡1例，多发骨折、术后严重感染行截3肢1例，肢体成活13例。13例得到随访，随访6～45个月，骨折在6个月内获得愈合12例。膝关节功能采用Merchan标准评定，优11例，可1例，差1例 ，膝关节功能的优良率为85％。结论 浮膝合并血管神经损伤，只要掌握好手术时机并尽早手术，选择合适的骨折固定方案，熟练利用显微外科技术处理血管神经损伤，伤肢能够得以保全恢复良好的功能。浮膝的分型中应增加伴发血管神经损伤的分型。

Study on treatment of traumatic floating knee associated with vascular and never injury

Objective To study the treatment of traumatic floating knee associated with vascular and never injury.Methods A retrospective analysis was carried out on 15 patients suffering form floating knee associated with vascular and never injury.The fracture were treated with locking nail fixation,plate and external fixation.To repair vascular injure by the way of transptanlation,decompressor,dilatation,repair and anastomosis of injured of blood vessels.To repair nerve injure by neurolysis,anastomosis and transplatation of newes.Results One case died of internal hemorrhage of abdomen and injury of brain.One case complicated with severe open fracture was infected and amputated.Thirteen cases were followed up from 6 month to 45 month and survive with fine appearance and good function.Using Merchan's knee scale,the rate of clinical result was excellent in 11,fair in 1 and poor in 1.Conclusion The floating knee injury associated with vascular and never injury should be operated as early as possible under comprehensive condition circumstance.Select fixation project according to fracture type.Functional reconstruction was performed according to status of nerve recovery.