Bernhoff K, Björck M
Uppsala University, SE 75185, Uppsala, Sweden.
Bone Joint J. 2015 Feb;97-B(2):192-6. doi: 10.1302/0301-620X.97B2.34353.
We have investigated iatrogenic popliteal artery injuries (PAI) during non arthroplasty knee surgery regarding mechanism of injury, treatment and outcomes, and to identify successful strategies when injury occurs. In all, 21 iatrogenic popliteal artery injuries in 21 patients during knee surgery other than knee arthroplasty were identified from the Swedish Vascular Registry (Swedvasc) between 1987 and 2011. Prospective registry data were supplemented with case-records, including long-term follow-up. In total, 13 patients suffered PAI during elective surgery and eight during urgent surgery such as fracture fixation or tumour resection. Nine injuries were detected intra-operatively, five within 12 to 48 hours and seven > 48 hours post-operatively (two days to 23 years). There were 19 open vascular and two endovascular surgical repairs. Two patients died within six months of surgery. One patient required amputation. Only six patients had a complete recovery of whom had the vascular injury detected at time of injury and repaired by a vascular surgeon. Patients sustaining vascular injury during elective procedures are more likely to litigate (p = 0.029). We conclude that outcomes are poorer when there is a delay of diagnosis and treatment, and that orthopaedic surgeons should develop strategies to detect PAI early and ensure rapid access to vascular surgical support.
我们对非关节置换膝关节手术期间医源性腘动脉损伤（PAI）的损伤机制、治疗方法及结果进行了研究，以确定损伤发生时的成功应对策略。1987年至2011年期间，从瑞典血管登记处（Swedvasc）共识别出21例膝关节手术（非膝关节置换术）患者发生的21例医源性腘动脉损伤。前瞻性登记数据辅以病例记录，包括长期随访。总计，13例患者在择期手术期间发生PAI，8例在紧急手术（如骨折固定或肿瘤切除）期间发生。9例损伤在术中被发现，5例在术后12至48小时内被发现，7例在术后超过48小时（2天至23年）被发现。进行了19例开放血管手术修复和2例血管腔内手术修复。2例患者在术后6个月内死亡。1例患者需要截肢。只有6例患者完全康复，其中血管损伤在受伤时被发现并由血管外科医生进行修复。在择期手术过程中发生血管损伤的患者更有可能提起诉讼（p = 0.029）。我们得出结论，诊断和治疗延迟时结果较差，骨科医生应制定策略以早期发现PAI，并确保能迅速获得血管外科支持。
