Coleman Jamie J, Tavoosi Saharnaz, Zarzaur Ben L, Brewer Brian L, Rozycki Grace S, Feliciano David V
Indiana Unversity School of Medicine, Indianapolis, Indiana, USA.
Am Surg. 2016 Sep;82(9):820-4.
Problems related to the combination of an arterial injury and a blunt fracture in the lower extremity are well known-delayed diagnosis, damaged soft tissue, and high amputation rate. The actual incidence of this injury pattern is, however, unknown. The purposes of this study were to determine the current incidence of named arterial injuries in patients with blunt fractures in the lower extremities and assess potential associated risk factors. This was a 7-year (2007-2013) retrospective review of patients ≥18 years with blunt lower extremity fractures at a Level I trauma center. Fracture location and concomitant arterial injury were determined and patients stratified by age, gender, and injury velocity. Low injury velocity was defined as falls or assaults, whereas an injury secondary to a motorized vehicle was defined as high velocity. A total of 4413 patients (mean age 52.2 years, 54.3% male, mean Injury Severity Score 13.1) were identified. Forty-six patients (1.04%) had arterial injuries (20.4% common femoral, 8.2% superficial femoral, 44.9% popliteal, and 26.5% shank). After stratifying by age and injury velocity, younger age was associated with a significantly higher rate of vascular injury. For high-velocity injuries, there was no difference based on age. In conclusion, the prevalence of arterial injury after blunt lower extremity fractures is 1.04 per cent in our study. A significant paradoxical relationship exists between age and associated arterial injuries in patients with low-velocity injuries. If these data are confirmed in future studies, a low index of suspicion in patients >55 years after falls is appropriate.
下肢动脉损伤与钝性骨折合并存在的相关问题众所周知，如诊断延迟、软组织损伤以及高截肢率。然而，这种损伤模式的实际发生率尚不清楚。本研究的目的是确定下肢钝性骨折患者中命名动脉损伤的当前发生率，并评估潜在的相关危险因素。这是一项对一级创伤中心18岁及以上下肢钝性骨折患者进行的为期7年（2007 - 2013年）的回顾性研究。确定骨折部位和合并的动脉损伤，并根据年龄、性别和损伤速度对患者进行分层。低损伤速度定义为跌倒或袭击，而机动车导致的损伤定义为高速度损伤。共识别出4413例患者（平均年龄52.2岁，男性占54.3%，平均损伤严重程度评分为13.1）。46例患者（占1.04%）存在动脉损伤（股总动脉损伤占20.4%，股浅动脉损伤占8.2%，腘动脉损伤占44.9%，小腿动脉损伤占26.5%）。按年龄和损伤速度分层后，较年轻患者的血管损伤发生率显著更高。对于高速损伤，基于年龄无差异。总之，在我们的研究中，下肢钝性骨折后动脉损伤的患病率为1.04%。在低速损伤患者中，年龄与相关动脉损伤之间存在显著的矛盾关系。如果这些数据在未来研究中得到证实，对于55岁以上跌倒患者应保持较低的怀疑指数。
