膝关节周围骨折合并血管神经损伤的保肢治疗

目的探讨膝关节周围骨折合并血管神经损伤的保肢治疗方法。方法对14例膝关节周围骨折合并血管神经损伤患者进行保肢治疗,先固定骨折:外固定架固定10例,钢板内固定4例;再行血管修复:直接修补3例,端端吻合3例,自体血管桥接修复8例。对于术后出现肌肉坏死合并感染行彻底清创及负压封闭引流。结果 1例截肢;1例术后吻合血管处血栓形成,二期行自体血管桥接修复。13例保肢成功患者获得6~20个月随访。骨折均愈合良好,其中11例对线良好,1例内翻成角,1例外翻成角。末次随访膝关节活动范围伸150°~160°,屈90°~100°。结论膝关节周围骨折血管损伤的早期诊断和处理十分重要,注重修复顺序及血管吻合是避免肌肉坏死及感染的关键;术后出现肌肉坏死合并感染应彻底清创,并采用负压吸引冲洗引流的方法治疗。

Limb salvage treatment of fracture around knee joint with vascular nerve injury

Objective To investigate the effect of limb salvage treatment for fracture of knee joint with vascular nerve injury. Methods Limb salvage treatment was performed in 14 patients fracture of the knee joint with vascular injury. Firstly fixed fracture, 10 cases of external fixation and 4 cases of steel plate internal fixation;vascular repair was per-formed in 3 cases,which were performed by direct repair, 3 cases were performed end to end anastomosis, and 8 ca-ses were repaired by autologous blood vessel bridge repair. For the postoperative patients with muscle necrosis and in-fection, thorough debridement and vacuum sealing drainage were performed. Results There were 1 case of amputa-tion,1 case of postoperative anastomotic thrombosis,autologous vascular bridge repair in the two phase,13 cases of successful patients were followed for 6~20 months. Fractures was healed well,among them,11 cases were good to the line,1 case turned into angle,1 case was turned into angle. The range of extension of the knee joint was 150° ~160°,and the range of flexion was 90° ~ 100°. Conclusions It is very important for the early diagnosis and treat-ment of vascular nerve injury around the knee joint fracture,and focus on repair sequence and vascular anastomosis is the key to avoid muscle necrosis and infection;postoperative muscle necrosis and infection should be completely de-brided and treated with vacuum sealing drainage.