Blasier R B, Pape J M
Section of Orthopaedic Surgery, University of Michigan, Ann Arbor 48109-0328.
Clin Orthop Relat Res. 1991 May(266):214-7.
Life-threatening hemorrhage of the femoral vasculature from a blunt injury to the thigh without femoral fracture has not been emphasized in the medical literature. Two cases of massive hemorrhage from the deep femoral system resulted from blunt injury to the thigh without femoral fracture. In the first case, a diagnosis of compartment syndrome was based on muscle swelling from the blunt trauma. A fasciotomy uncovered life-threatening bleeding. In the second case, which had a similar history and clinical symptoms, a vascular injury was suspected and an arteriogram was done. Disruption of the deep femoral arterial system was detected, and fluoroscopic embolization controlled the bleeding. A routine fasciotomy was then done. Both patients appeared clinically to have a thigh compartment syndrome, presumably based on injury from the crushed muscle. They both had normal arterial pulsations distal to the injured thigh. The only feature that suggested a vascular injury was a need for transfusion for hemodynamic support in excess of apparent blood loss. Arteriography, with embolization if necessary, is advised for all cases of suspected thigh compartment syndrome in which there is an unexplained need for hemodynamic support by transfusion.
大腿钝性损伤未发生股骨骨折但出现危及生命的股血管出血情况，在医学文献中未得到充分强调。两例因大腿钝性损伤未发生股骨骨折而导致股深系统大量出血的病例。第一例中，基于钝性创伤导致的肌肉肿胀诊断为骨筋膜室综合征。筋膜切开术发现了危及生命的出血。第二例有类似病史和临床症状，怀疑有血管损伤并进行了动脉造影。检测到股深动脉系统中断，通过透视下栓塞控制了出血。随后进行了常规筋膜切开术。两名患者临床上均表现为大腿骨筋膜室综合征，推测是基于挤压肌肉造成的损伤。他们受伤大腿远端的动脉搏动均正常。提示血管损伤的唯一特征是因血流动力学支持需要输血，且输血量大超过明显失血。对于所有疑似大腿骨筋膜室综合征且存在无法解释的因输血进行血流动力学支持需求的病例，建议进行动脉造影检查，必要时进行栓塞治疗。
