Käch K, Künzi W, von Wartburg U, Largiadèr J
Klinik für Unfallchirurgie, Universitätsspital Zürich.
Helv Chir Acta. 1991 Feb;57(5):753-7.
Lower extreemity injury complicated by limb-threatening vascular injuries of the popliteal artery present an infrequent but difficult management problem. In a retrospective study 37 consecutive patients with severely injured lower extremities after blunt trauma, all complicated by popliteal vascular injury, were evaluated. In 10 patients we found severe management errors: In 7 patients a delay in diagnosis of the vascular injury, in 3 patients with extensive bone and soft-tissue damage an inadequate stabilisation of the fracture. The optimal management of complex injury with associated vascular injuries requires a high index of suspicion and a treatment of all components of such an injury. The initial goals are the accurate diagnosis or exclusion of arterial injury, surgical debridement, adequate bony stabilization with minimal additional bone and soft-tissue trauma, revascularisation by interposition of a vein graft after resection of the damaged segment, immediate fascial decompression and early soft-tissue reconstruction.
下肢损伤合并危及肢体的腘动脉血管损伤是一个少见但处理困难的问题。在一项回顾性研究中，对37例钝性创伤后下肢严重损伤且均合并腘血管损伤的连续患者进行了评估。我们发现10例患者存在严重的处理错误：7例患者血管损伤诊断延迟，3例广泛骨和软组织损伤患者骨折固定不充分。伴有血管损伤的复杂损伤的最佳处理需要高度的怀疑指数并对这类损伤的所有组成部分进行治疗。初始目标是准确诊断或排除动脉损伤、手术清创、以最小的额外骨和软组织创伤进行充分的骨固定、在切除受损节段后通过静脉移植进行血管重建、立即进行筋膜减压和早期软组织重建。
