Ballard J L, Bunt T J, Malone J M
Department of Surgery, Maricopa Medical Center, Phoenix, Arizona 85010.
Am J Surg. 1992 Oct;164(4):316-9. doi: 10.1016/s0002-9610(05)80895-5.
This 11-year retrospective study reviewed 99 arterial injuries distal to the brachial bifurcation or popliteal trifurcation in 89 extremities in 88 patients. Associated injuries occurred in 78 of 88 (89%) patients, including 10 fractures or dislocations, 66 nerve injuries, and 59 single or multiple tendon injuries. Fasciotomy was performed in 9 upper extremities and 11 lower extremities (23% of patients). The selection of operative treatment by arterial repair or ligation was by surgeon choice (52% repair and 48% ligation). Postoperative patency was found in 45 of 47 (96%) repaired arteries. In cases of isolated single arterial injuries (10), there were excellent results, and there was no difference in the results between repair and ligation. In cases of nonisolated single arterial injuries (69), there were 46% and 36% nonvascular complications in the repaired and ligated groups, respectively. In 10 patients with nonisolated multiple arterial injuries in the same extremity, the results of repair of one artery with ligation of the other artery versus repair of both arteries were identical, and there were no vascular complications. Operative exploration was the key to complete evaluation of vascular and neuro/musculoskeletal injuries. The data suggest that one functional artery distal to the elbow or knee is sufficient for limb viability and vascular function (follow-up range: 0 to 110 months; mean: 12 months). Nerve injury was the single most important factor of extremity injury in terms of the degree of functional loss.
这项为期11年的回顾性研究对88例患者89条肢体中99处位于肱动脉分叉或腘动脉三叉分支远端的动脉损伤进行了评估。88例（89%）患者伴有其他损伤，包括10例骨折或脱位、66例神经损伤以及59例单处或多处肌腱损伤。9例上肢和11例下肢（占患者总数的23%）进行了筋膜切开术。动脉修复或结扎的手术治疗方式由外科医生选择（52%为修复，48%为结扎）。47条接受修复的动脉中有45条（96%）术后保持通畅。在单纯单处动脉损伤的病例（10例）中，治疗效果良好，修复和结扎两组的结果无差异。在非单纯单处动脉损伤的病例（69例）中，修复组和结扎组的非血管并发症发生率分别为46%和36%。在同一肢体存在非单纯多处动脉损伤的10例患者中，一条动脉修复而另一条动脉结扎与两条动脉均修复的结果相同，且无血管并发症。手术探查是全面评估血管及神经/肌肉骨骼损伤的关键。数据表明，肘或膝远端一条功能正常的动脉足以维持肢体存活及血管功能（随访时间范围：0至110个月；平均12个月）。就功能丧失程度而言，神经损伤是肢体损伤最重要的单一因素。
