Xie Xian-kuan, Li Hang, Zheng Qiang, Pan Zhi-jun, Yang Di-sheng
Department of Orthopaedics, the Second Hospital Affiliated Medical School of Zhejiang University, Hangzhou 310009, China.
Zhonghua Wai Ke Za Zhi. 2009 Dec 1;47(23):1794-7.
To investigate the effect and influence factors on knee joint peripheral fractures and/or dislocations with an associated vascular injury through retrospectively study.
From March 2002 to November 2007 31 patients with knee joint peripheral fractures and/or dislocations with an associated vascular injury were treated, including 24 males and 7 females with a mean age of 41 years (range from 21 to 62 years). Definite diagnosis of vascular injury by combining colored ultrasonic, CTA, operative exploration with clinical signs, fixing fractures and/or dislocations with fixators, plates and screws, reconstructing blood circulation based on the condition of the vascular injury by vascular repair, homograft vein or artificial vascular grafting separately and analysing the effects of PSI, diagnosis and treatment methods on salvage lower extremities.
Successful reconstruction was carried out in 31 cases, however there were 1 death because of mult-fractures and brain injury and 6 amputation, 24 cases successful salvage followed up mean 24.2 months, 6 cases bone nonunion and infected bone defect were cured by delayed bone planting or bone transportation. Ligaments repair reconstruction of 7 cases knee joint dislocation were done in delayed 3 or 4 weeks after first operation, the good functional rate was 71.4%.
The patients of PSI under 10 grades in knee joint peripheral fractures and/or dislocations with an associated vascular injury should been carried out treatment, early definite diagnosis and blood circulation reconstruction are the key factors of successful salvage treatment.
通过回顾性研究探讨膝关节周围骨折和/或脱位合并血管损伤的治疗效果及影响因素。
2002年3月至2007年11月,对31例膝关节周围骨折和/或脱位合并血管损伤的患者进行治疗,其中男性24例,女性7例,平均年龄41岁(21~62岁)。综合彩色超声、CTA、手术探查及临床体征明确血管损伤诊断,采用外固定架、钢板及螺钉固定骨折和/或脱位,根据血管损伤情况分别采用血管修复、同种异体静脉移植或人工血管移植重建血液循环,并分析PSI、诊断及治疗方法对挽救下肢的影响。
31例均成功重建,1例因多发骨折及颅脑损伤死亡,6例行截肢术,24例成功挽救,平均随访24.2个月,6例骨不连及感染性骨缺损经延期植骨或骨搬运治愈。7例膝关节脱位患者于首次手术后3或4周延期行韧带修复重建,优良率为71.4%。
膝关节周围骨折和/或脱位合并血管损伤且PSI在10级以下的患者应进行治疗,早期明确诊断及重建血液循环是挽救治疗成功的关键因素。