Jagdish Krishnan, Paiman M, Nawfar As, Yusof Mi, Zulmi W, Azman Ws, Halim As, Mat Saad Az, Shafei Md, Faisham Wi
Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Malays Orthop J. 2014 Mar;8(1):14-20. doi: 10.5704/MOJ.1403.012.
A seven years retrospective study was performed in 45 consecutive vascular injuries in the extremities to investigate the pattern of injuries, managements and outcomes. Motor-vehicle accidents were the leading cause of injuries (80%), followed by industrial injuries (11.1%) and iatrogenic injuries (4.4%). Popliteal and brachial artery injuries were commonly involved (20%). Fifteen (33.3%) patients had fractures, dislocation or fracture dislocation around the knee joint and 6 (13.3%) patients had soft tissue injuries without fracture. Traumatic arterial transection accounted for 34 (75.6%) cases, followed by laceration in 7 (15.6%) and 9 (6.7%) contusions. Associated nerve injuries were seen in 8 (17.8 %) patients using intra-operative findings as the gold standard, both conventional angiogram (CA) and computerized tomography angiogram (CTA) had 100% specificity and 100% sensitivity in determining the site of arterial injuries. The mean ischemic time was 25.31 hours (4 - 278 hours). Thirty-three (73.3 %) patients were treated more than 6 hours after injury and 6 patients underwent revascularization after 24 hours; all had good collateral circulation without distal pulses or evidence of ischemic neurological deficit. The mean ischemic time in 39 patients who underwent revascularization within 24 hours was 13.2 hours. Delayed amputation was performed in 5 patients (11.1%). Of the 6 patients who underwent delayed revascularization, one patient had early amputation, one -had delayed amputation following infection and multiple flap procedures while the rest of the patients' limbs survived. Joint stiffness was noted in 10 patients (22.2%) involving the knee joint, elbow and shoulder in two patients each. Infection was also noted in 5 patients (11.1%) with two of them were due to infected implants. Other complications encountered included nonunion (2 patients, 4.4%), delayed union (1 patient, 2.2%),limb length discrepancy (1 patient, 2.2%), hematoma (1 patient, 2.2%) and leaking anastomosis in one patient (2.2%). Volkmann's ischemic contracture occurred in 3 (6.7%) patients. There was no complication noted in 8 (17.8%) patients Three patients (6.7%) died of whom two were not due to vascular causes. We conclude that early detection and revascularization of traumatic vascular injuries is important but delayed revascularization also produced acceptable results.
对45例连续的四肢血管损伤患者进行了一项为期七年的回顾性研究，以调查损伤模式、治疗方法及治疗结果。机动车事故是损伤的主要原因（80%），其次是工业损伤（11.1%）和医源性损伤（4.4%）。腘动脉和肱动脉损伤最为常见（20%）。15例（33.3%）患者在膝关节周围发生骨折、脱位或骨折脱位，6例（13.3%）患者有软组织损伤但无骨折。外伤性动脉横断占34例（75.6%），其次是撕裂伤7例（15.6%）和挫伤9例（6.7%）。以术中发现为金标准，8例（17.8%）患者伴有神经损伤，传统血管造影（CA）和计算机断层血管造影（CTA）在确定动脉损伤部位时特异性和敏感性均为100%。平均缺血时间为25.31小时（4 - 278小时）。33例（73.3%）患者在受伤后6小时以上接受治疗，6例患者在24小时后进行了血管重建；所有患者均有良好的侧支循环，无远端脉搏或缺血性神经功能缺损迹象。39例在24小时内进行血管重建的患者平均缺血时间为13.2小时。5例（11.1%）患者进行了延迟截肢。在6例接受延迟血管重建的患者中，1例患者早期截肢，1例患者在感染和多次皮瓣手术后延迟截肢，其余患者肢体存活。10例（22.2%）患者出现关节僵硬，其中膝关节、肘关节和肩关节各2例。5例（11.1%）患者出现感染，其中2例是由于植入物感染。其他并发症包括骨不连（2例，4.4%）、骨延迟愈合（1例，2.2%）、肢体长度差异（1例，2.2%）、血肿（1例，2.2%）和1例患者吻合口漏（2.2%）。3例（6.7%）患者发生Volkmann缺血性挛缩。8例（17.8%）患者未出现并发症。3例（6.7%）患者死亡，其中2例并非死于血管相关原因。我们得出结论，创伤性血管损伤的早期检测和血管重建很重要，但延迟血管重建也能产生可接受的结果。
