膝关节周围骨折脱位合并腘动脉损伤

[目的]回顾性分析膝关节周围骨折、膝关节脱位合并胭动脉损伤的早期诊断、治疗。[方法]自1998年3月～2005年5月，共收治膝关节周围骨折、脱位合并有胭动脉损伤患者71例，通过临床检查、血管造影或（和）Doppler检查，及早明确诊断，及时手术探查，修复损伤的动脉、采用简单、快捷、可靠的方法稳定骨折，术后抗凝、解痉、预防感染治疗。[结果]15例伴有严重的小腿软组织毁损初期截肢，其余56例手术成功修复。骨折采用带锁髓内钉固定、钢板螺钉固定或外支架固定。术后吻合口处发生血栓形成2例，经Doppler检查证实后急诊切除血栓部，取自体大隐静脉逆转移植吻合成功。2例发生骨髓炎（均为开放性骨折），经病灶清除庆大霉素骨水泥链珠植入等处理后愈合。2例发生创伤性膝关节炎。其余骨折愈合良好，肢体功能恢复较好。[结论]膝关节周围骨折、脱位应高度怀疑合并有胭血管损伤，通过仔细临床检查，必要时结合Doppler、血管造影尽早明确诊断，及早手术探查修复损伤的血管，稳定骨折。

Popliteal artery injury associated with dislocation and fracture around the knee

[Objective]To analyze the early diagnosis and treatment of the popliteal artery injury associated with the dislocation and fracture of the knee.[Method]A total of 71 cases of popliteal artery injury associated with the dislocation and fracture of the knee were treated from March 1998 to May 2005.Properative(vascular examization) and operative(methods of arterial repair,venous repair-ligation,anticoagulation-thrombolytic therapy,fracture reduction and internal fixation,fasciotomy) treatment were studied.[Result]Totally 15 cases were primary amputation and 56 cases were performed vascular repair and the fractures and dislocations were reduced and fixed by internal or external fixation.Two cases had thrombosis at the repaired site confirmed by Doppler and had to perform second operation to remove thrombus and repair the popliteal by autograft of the saphena magna vein.At the follow-up,2 cases had chronic osteomyelitis and 2 cases had traumatic arthritis.[Conclusion]It is postulated that a rational and prompt diagnosis and treatment of popliteal artery injury associated with dislocation and fracture around the knee would decrease the adverse effects of ischemia and reduce the overall morbidity.