Department of Orthopaedic Surgery, Temple University Hospital, Philadelphia, PA 19140, USA.
Orthop Surg. 2012 Aug;4(3):166-71. doi: 10.1111/j.1757-7861.2012.00186.x.
To retrospectively investigate the experience at one urban level one trauma center with gunshot femoral fractures with vascular injury and to examine the implication of surgical sequence with regards to short-term complications and ischaemia time.
We performed a retrospective study of 24 patients treated at an urban level one trauma center over a 10-year period with low velocity gunshot wounds resulting in femur fractures and major vascular injury. Data were stratified according to sequence of surgical intervention.
The mean age was 31.3 years. Mean time to revascularization was highest in patients undergoing definitive orthopaedic fixation first (660 min) and lowest in patient undergoing shunting first (210 min). Most complications in patients undergoing vascular repair first, included two disrupted repairs requiring immediate revision after subsequent orthopaedic fixation. Other complications included compartment syndrome and one amputation.
Surgical sequence did not appear to impact the outcome with regard to limb loss, compartment syndrome, or mortality. Orthopaedic repair following vascular repair, however, is a risk for disruption of the vascular repair. We suggest that close and early direct communication between the orthopaedic and vascular surgeons take place in order to facilitate a satisfactory outcome.
回顾性调查一家市级一级创伤中心治疗伴有血管损伤的枪伤股骨骨折的经验，并研究手术顺序对短期并发症和缺血时间的影响。
我们对一家市级一级创伤中心在 10 年期间治疗的 24 例低能率枪伤导致股骨骨折和主要血管损伤的患者进行了回顾性研究。根据手术干预的顺序对数据进行分层。
患者的平均年龄为 31.3 岁。接受确定性骨科固定术的患者再血管化时间最长（660 分钟），接受分流术的患者最短（210 分钟）。接受血管修复术的患者中，大多数并发症包括两次修复失败，需要随后的骨科固定术立即修复。其他并发症包括筋膜间室综合征和一例截肢。
手术顺序似乎并没有对肢体丧失、筋膜间室综合征或死亡率产生影响。然而，血管修复后进行骨科修复存在血管修复失败的风险。我们建议骨科和血管外科医生之间进行密切和早期的直接沟通，以促进满意的结果。
