Lakhwani M N, Gooi B H, Barras C D J
Penang Adventist Hospital, Penang.
Med J Malaysia. 2002 Dec;57(4):426-32.
The nature of vascular trauma varies greatly between continents and across time. The aim of this study was to prospectively analyse the demographics, pathology, management and clinical outcomes of vascular injuries in two urban Malaysian hospitals and review of international literature on vascular trauma. From this information, preliminary management and preventive implications will be described.
Eighty-four consecutive cases of trauma requiring vascular surgery were prospectively analysed over three years at Hospital Kuala Lumpur and Hospital Pulau Pinang, Malaysia. Extensive patient demographic and injury data, including the mechanism of injury, associated injuries, angiographic findings, operative details and post-operative complications, were systematically gathered.
Most vascular injuries were incurred by males (76/84), with 37% (28/76) of them aged between 21 and 30 years. Malays were most frequently injured (n = 36) followed by Chinese and Indians. Road traffic accidents (n = 49) substantially outnumbered all other causes of injury. Lower limb injuries (n = 57) occurred more than twice as often as upper limb injuries (n = 27). Complete arterial transections (n = 43) and intimal injuries (n = 27) were more common than arterial lacerations (n = 10) and pseudoaneurysms (n = 4). The most frequently damaged vessels were the popliteal/tibioperoneal trunk (n = 33). All patients received urgent Doppler ultrasound assessment and, where possible, ankle-brachial systolic index measurement. Of all patients, 40 received an angiogram, haemodynamic instability making this investigation impractical in others. Primary arterial repair was the most frequently employed surgical procedure (n = 54) followed by autogenous reverse long saphenous vein (LSV) interposition graft (n = 14), embolectomy (n = 5) and PTFE interposition graft (n = 3). The most common post-operative complication was wound infection (n = 11). Amputation, as a last resort, was required in 13 cases following either primary or autogenous reverse LSV repair complicated by sepsis or critical ischaemia.
Vascular trauma, especially in conjunction with severe soft tissue, nerve or orthopaedic injury carries colossal physical, psychological, financial and social costs. Associated nerve and venous injury portended poor outcome in this study. Whilst orthopaedic trauma was a common association, the concurrence of occult vascular trauma and soft tissue injury without fracture emphasises the crucial importance of thorough and rapid clinical vascular assessment, investigation and surgical intervention. Fasciotomy, especially for the lower limb, is important for the prevention of compartment syndrome and its, limb-threatening sequelae. Primary preventive road safety promotion and interventions, with attention to high-risk groups (young males and motorcyclists), is urgently required.
不同大陆以及不同时期，血管创伤的性质差异很大。本研究旨在对马来西亚两家城市医院血管损伤的人口统计学、病理学、治疗方法及临床结果进行前瞻性分析，并回顾国际上有关血管创伤的文献。根据这些信息，将阐述初步的治疗方法及预防意义。
在马来西亚吉隆坡医院和槟城医院，对连续三年需进行血管手术的84例创伤病例进行前瞻性分析。系统收集了广泛的患者人口统计学和损伤数据，包括损伤机制、合并损伤、血管造影结果、手术细节及术后并发症。
大多数血管损伤患者为男性（76/84），其中37%（28/76）年龄在21至30岁之间。马来人受伤最为频繁（n = 36），其次是华人和印度人。道路交通事故（n = 49）在所有损伤原因中占比远超其他。下肢损伤（n = 57）的发生频率是上肢损伤（n = 27）的两倍多。完全动脉横断（n = 43）和内膜损伤（n = 27）比动脉撕裂（n = 10）和假性动脉瘤（n = 4）更为常见。最常受损的血管是腘动脉/胫腓干（n = 33）。所有患者均接受了紧急多普勒超声评估，并在可能的情况下测量了踝肱收缩压指数。所有患者中，40例接受了血管造影，血流动力学不稳定使其他患者无法进行此项检查。一期动脉修复是最常用的外科手术（n = 54），其次是自体逆行大隐静脉（LSV）移植（n = 14）、取栓术（n = 5）和聚四氟乙烯移植（n = 3）。最常见的术后并发症是伤口感染（n = 11）。在13例患者中，因一期或自体逆行LSV修复术后并发败血症或严重缺血，作为最后手段进行了截肢。
血管创伤，尤其是合并严重软组织、神经或骨科损伤时，会带来巨大的身体、心理、经济和社会成本。在本研究中，合并神经和静脉损伤预示着预后不良。虽然骨科创伤是常见的合并症，但隐匿性血管创伤与无骨折的软组织损伤同时存在，凸显了全面快速的临床血管评估及手术干预的至关重要性。筋膜切开术，尤其是对下肢而言，对于预防骨筋膜室综合征及其威胁肢体的后遗症很重要。迫切需要开展以预防为主的道路安全宣传及干预措施，关注高危人群（年轻男性和骑摩托车者）。
