Qi Feng, Li Jie, Qi Xiao, Xiao Lu-wei
Zhongguo Gu Shang. 2015 Oct;28(10):932-5.
To study the ischemic times of the main artery injury in the limbs and the influence on the limbs survival rate, and to analyze the reasons for the formation of the ischemia time.
From June 1996 to November 2012, 83 patients with completely severed limb main artery treated in our hospital were retrospectively studied. There were 77 males and 6 females, including 81 adults (ranging in age from 16 to 52 years old, with a median age of 35 years old) and 2 children (4 and 5 years old respectively). Seventy-five patients were treated with end to end anastomosis, 7 patients were treated with great saphenous vein transplantation, and 1 patient was treated with artificial blood vessel transplantation. The prior to admission ischemia time, after admission ischemia time and total ischemia time for successful and unsuccessful patients, as well as the causes of the formation of the ischemia time were studied. Limb survival rate of different ischemic time was counted. Sharpness injury or blunt injury ischemia time and amputation rate were researched statistically. All data were analyzed using SPSS statistical software.
There were 72 limbs survived, 11 amputated. The average ischemia time was (7.45±5.94) h for limb-salvage group and (13.73±14.00) h for amputation group. Prior to admission ischemia time between amputation and limb-salvage group had no significant difference. After admission the ischemia time in amputation group was longer than limb-salvage group. The amputation rate for ischemia time 21 to 44 h group was higher than other three groups (≤ 5 h, 6 to 10 h, 11 to 20 h) (P=0.023, 0.038, 0.044). Amputation reasons can be divided into anastomosis failure in the operation, vascular thrombosis 2 to 4 days after operation and late infection.
Vascular injury limbs can tolerate longer ischemia time and the limb salvage succeed. Only too long ischemia time (> 20 h), limb amputation rate increases significantly. The main cause of long time ischemia is delayed diagnosis in the hospital. Whether limb-salvage success mainly depends on the degree of trauma and the quality of the anastomosis than ischemia time.
研究肢体主要动脉损伤的缺血时间及其对肢体成活率的影响，并分析缺血时间形成的原因。
回顾性研究1996年6月至2012年11月在我院治疗的83例肢体主要动脉完全离断患者。男77例，女6例，其中成人81例（年龄16～52岁，中位年龄35岁），儿童2例（分别为4岁和5岁）。75例行端端吻合术，7例行大隐静脉移植术，1例行人工血管移植术。研究成功与未成功患者入院前缺血时间、入院后缺血时间及总缺血时间，以及缺血时间形成的原因。统计不同缺血时间的肢体成活率。对锐器伤或钝器伤的缺血时间及截肢率进行统计学研究。所有数据采用SPSS统计软件进行分析。
72例肢体成活，11例截肢。保肢组平均缺血时间为（7.45±5.94）h，截肢组为（13.73±14.00）h。截肢组与保肢组入院前缺血时间差异无统计学意义。入院后截肢组缺血时间长于保肢组。缺血时间21～44 h组截肢率高于其他三组（≤5 h、6～10 h、11～20 h）（P=0.023、0.038、0.044）。截肢原因可分为手术中吻合失败、术后2～4天血管血栓形成及后期感染。
血管损伤肢体能耐受较长缺血时间且保肢成功。只有缺血时间过长（>20 h），肢体截肢率才会显著增加。长时间缺血的主要原因是医院内诊断延误。保肢是否成功主要取决于创伤程度和吻合质量而非缺血时间。
