Yahya Mazri M, Mwipatayi Bibombe P, Abbas Manzoor, Rao Suhakar, Sieunarine Kishore
Department of Vascular Surgery and General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
ANZ J Surg. 2005 Oct;75(10):882-6. doi: 10.1111/j.1445-2197.2005.03550.x.
Popliteal artery injury is uncommon but poses a significant challenge in Australian trauma care. Blunt trauma and knee dislocations appear to be associated with higher amputation rates. The aim of the present study was to review the authors' experience with this condition and discuss the best approach to investigation and management.
The medical records of all patients with popliteal artery injury (n = 19) who were entered prospectively onto the Royal Perth Hospital Trauma Registry from 1995 to 2003 were reviewed. Their demographic data, investigations, primary operative procedures, fasciotomy, primary and secondary amputation rates and mortality were determined.
There were 17 male and two female patients with a median age of 34 years (range 17-62 years). Most patients (84%) were under 40 years in age. Blunt trauma was the commonest cause of popliteal artery injury (68.4%), and 84.6% of the patients had associated skeletal injury. The amputation rate in the present study was 26.3% (5/19). There were no intraoperative or in-hospital deaths. Three of 13 patients (23%) with blunt trauma underwent amputation, compared to two of six (33.3%) with penetrating injury. Two of three amputee patients in the blunt trauma group had dislocated knees.
Despite technical improvements in management of popliteal artery injury, a high amputation rate is still seen, especially in patients with one or more of the following factors: extensive soft-issue injury, associated skeletal trauma, knee dislocation, and prolonged ischaemia time. Measures to reduce the amputation rate, ranging from more prompt diagnosis to modified surgical treatment techniques, are discussed.
腘动脉损伤并不常见，但在澳大利亚创伤护理中构成重大挑战。钝性创伤和膝关节脱位似乎与较高的截肢率相关。本研究的目的是回顾作者在这种情况下的经验，并讨论最佳的检查和处理方法。
回顾了1995年至2003年前瞻性纳入皇家珀斯医院创伤登记处的所有腘动脉损伤患者（n = 19）的病历。确定了他们的人口统计学数据、检查、初次手术操作、筋膜切开术、初次和二次截肢率以及死亡率。
有17例男性和2例女性患者，中位年龄为34岁（范围17 - 62岁）。大多数患者（84%）年龄在40岁以下。钝性创伤是腘动脉损伤最常见的原因（68.4%），84.6%的患者伴有骨骼损伤。本研究中的截肢率为26.3%（5/19）。术中或住院期间无死亡病例。13例钝性创伤患者中有3例（23%）接受了截肢，而6例穿透伤患者中有2例（33.3%）接受了截肢。钝性创伤组的3例截肢患者中有2例膝关节脱位。
尽管在腘动脉损伤的处理方面技术有所改进，但仍有较高的截肢率，特别是在具有以下一个或多个因素的患者中：广泛的软组织损伤、相关的骨骼创伤、膝关节脱位和较长的缺血时间。讨论了从更迅速的诊断到改良手术治疗技术等降低截肢率的措施。
