Kim John Y S, Buck Donald W, Forte Antonio J V, Subramanian Vairavan S, Birman Michael V, Schierle Clark F, Kloeters Oliver, Mattox Kenneth L, Wall Matthew J, Epstein Michael J
Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA.
J Trauma. 2009 Dec;67(6):1339-44. doi: 10.1097/TA.0b013e318197b999.
The brachial artery is the most common vascular injury encountered in upper extremity trauma. If not treated promptly, it can result in compartment syndrome (CS) and long-term disability. Here, we report an institutional experience of traumatic brachial artery injuries and establish risk factors for the development of upper extremity CS in this setting.
A retrospective review of 139 patients with traumatic brachial artery injury from 1985 to 2001 at a single institution. Patients were divided into two cohorts, those with evidence of CS and those without CS (NCS), for comparison.
One hundred thirty-nine patients presented with traumatic brachial artery injuries (mean age, 28.4 years). Twenty-nine patients (20.9%) were diagnosed with upper extremity CS, and 28 of these patients underwent fasciotomy on recognition of their CS. Seven patients (6.4%) in the NCS cohort underwent fasciotomy as a result of absent distal pulses on initial examination. Mean follow-up was 51.6 days. Two patients required revision of their arterial repair, and one patient underwent amputation. The risk of CS was increased in the presence of combined arterial injuries (p = 0.03), combined nerve injuries (p = 0.04), motor deficits (p < 0.0001), fractures, and increased intraoperative blood loss (p = 0.001). Multivariate logistic regression performed on these variables revealed that elevated intraoperative blood loss, combined arterial injury, and open fracture were independent risk factors for the development of CS (OR 1.12, 5.79, and 2.68, respectively).
Prompt evaluation and management of traumatic brachial artery injuries is important to prevent CS, which can lead to functional deficits. In the setting of combined arterial injury, open fracture, and significant intraoperative blood loss, prophylactic fasciotomy should be considered.
肱动脉损伤是上肢创伤中最常见的血管损伤。若不及时治疗，可导致骨筋膜室综合征（CS）和长期残疾。在此，我们报告一家机构关于创伤性肱动脉损伤的经验，并确定在此情况下上肢CS发生的危险因素。
回顾性分析1985年至2001年在一家机构就诊的139例创伤性肱动脉损伤患者。将患者分为两组，有CS证据的患者和无CS（NCS）的患者，进行比较。
139例患者出现创伤性肱动脉损伤（平均年龄28.4岁）。29例患者（20.9%）被诊断为上肢CS，其中28例患者在确诊CS后接受了筋膜切开术。NCS组中有7例患者（6.4%）因初次检查时远端脉搏消失而接受了筋膜切开术。平均随访时间为51.6天。2例患者需要对动脉修复进行翻修，1例患者接受了截肢手术。合并动脉损伤（p = 0.03）、合并神经损伤（p = 0.04）、运动功能障碍（p < 0.0001）、骨折以及术中失血增加（p = 0.001）时，CS的风险增加。对这些变量进行多因素逻辑回归分析显示，术中失血增加、合并动脉损伤和开放性骨折是CS发生的独立危险因素（OR分别为1.12、5.79和2.68）。
及时评估和处理创伤性肱动脉损伤对于预防可导致功能障碍的CS很重要。在合并动脉损伤、开放性骨折和术中大量失血的情况下，应考虑预防性筋膜切开术。
