巴基斯坦的肢体血管创伤。

Department of Surgery, Division of General Surgery, Jinnah Hospital and Allama Iqbal Medical College Complex, Lahore, Pakistan.

Saudi Med J. 2004 Apr;25(4):498-501.

OBJECTIVE

To report demographic data, etiological spectrum, the varied presentation, certain vascular techniques and their outcome in patients with peripheral vascular trauma.

METHODS

This study included the patients who presented to the emergency room of Jinnah Hospital and Allama Iqbal Medical College Complex, Lahore, Pakistan with acute peripheral vascular injuries from May 1998 to April 2002. The Mangled Extremity Severity Score (MESS) was calculated for each individual to determine the magnitude of injury. A trauma database was devised to analyze each patient's characteristics, time since the injury, etiology of trauma, clinical presentation, associated injuries, surgical procedures performed and the result.

RESULTS

Fifty-seven individuals were managed. The male to female ratio was 49:8 with an age range of 6-69 years (mean 29.1). The time since injury ranged 3-19 hours (mean 9.3). Thirty-one (54.3%) cases sustained vascular trauma by firearm, 10 (17.5%) by blunt trauma, 7 (12.2%) stabs, 6 (10.5%) machinery work and 3 (5.2%) by crush injury. Arterial bleeding from the wound was the most frequent presentation found in 18 (31.5%) patients followed by absent distal pulses recorded in 13 (22.8%) subjects. Fifty-one (89.5%) patients presented with arterial, 6 (10.5%) venous and 9 (15.7%) of these had concomitant arterial and venous injuries. Complete vascular transaction was the most common operative finding noted in 26 (45.6%) cases followed by partial tear in 23 (40.3%) subjects. Fifteen (29.4%) common femoral, 10 (19.6%) brachial, 9 (17.6%) superficial femoral, 7 (13.7%) axillary, 5 (9.8%) popliteal and 4 (7.8%) radial arteries were traumatized. The interposition vein graft was used in 21 (41.1%) cases while primary vascular repair was carried out in 19 (37.2%) patients. Forty-five (78.9%) subjects had a functional limb after vascular reconstruction. Wound infection was recorded in 7 (12.2%) individuals. Six (10.5%) amputations were carried out, all with an average MESS of 7.8 +/- 1. 3 (p<0.05). Three patients died within 10 hours of injury due to torrential hemorrhage.

CONCLUSION

Prompt surgical intervention, frequent use of saphenous vein graft and a low threshold for fasciotomy contributes to a successful outcome in patients with extremity vascular trauma.

目的

报告外周血管创伤患者的人口统计学数据、病因谱、不同表现、某些血管技术及其治疗结果。

方法

本研究纳入了1998年5月至2002年4月期间因急性外周血管损伤就诊于巴基斯坦拉合尔真纳医院和阿拉马·伊克巴勒医学院综合院区急诊室的患者。计算每位患者的肢体毁损伤严重程度评分（MESS）以确定损伤程度。设计了一个创伤数据库来分析每位患者的特征、受伤时间、创伤病因、临床表现、合并伤、实施的外科手术及结果。

结果

共治疗57例患者。男女比例为49:8，年龄范围为6 - 69岁（平均29.1岁）。受伤时间为3 - 19小时（平均9.3小时）。因火器伤导致血管创伤的有31例（54.3%），钝器伤10例（17.5%），刺伤7例（12.2%），机械伤6例（10.5%），挤压伤3例（5.2%）。伤口动脉出血是最常见的表现，18例（31.5%）患者出现，其次是13例（22.8%）患者出现远端脉搏消失。51例（89.5%）患者为动脉损伤，6例（10.5%）为静脉损伤，其中9例（15.7%）同时合并动脉和静脉损伤。完全血管离断是最常见的手术发现，26例（45.6%）出现，其次是23例（40.3%）部分撕裂。股总动脉损伤15例（29.4%），肱动脉10例（19.6%），股浅动脉9例（17.6%），腋动脉7例（13.7%），腘动脉5例（9.8%），桡动脉4例（7.8%）。21例（41.1%）患者采用了静脉移植术，19例（37.2%）患者进行了一期血管修复。血管重建后45例（78.9%）患者肢体功能良好。7例（12.2%）患者出现伤口感染。6例（10.5%）患者接受了截肢手术，所有患者的平均MESS为7.8±1.3（p<0.05）。3例患者在受伤后10小时内因大出血死亡。