Zhang Bin-Fei, Cong Yu-Xuan, Wang Peng-Fei, Huang Hai, Wang Hu, Zhuang Yan
Department of Orthopedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Beilin District, Xi'an, Shaanxi Province, China.
Medicine (Baltimore). 2018 Feb;97(6):e9872. doi: 10.1097/MD.0000000000009872.
Complications involving vascular injuries after hip fracture are rare, and the diagnosis and management of deep femoral artery (DFA) injuries are challenging. We reported 4 cases of DFA injuries after hip fracture surgery and aimed to discuss their early detection, treatment, and prevention.
We reviewed 4 cases of deep femoral injury after hip fracture. Case 1: a 71-year-old woman suffered a fracture around a prosthesis. Cases 2-4: 2 men and 1 woman suffered subtrochanteric or intertrochanteric fracture. DFA branch pseudoaneurysm formation and injury were found via arteriography after surgery. All the patients were diagnosed with DFA branch pseudoaneurysm formation and injury. Percutaneous intervention therapy was used to block the pseudoaneurysms with coil or gel.
Among the cases, the main symptoms were severe pain or swelling with large-scale ecchymosis in the thigh or perineum. We used arterial duplex to diagnose pseudoaneurysm and treated the injury using interventional intravascular embolization. In Case 1, damage by the guide wire used during surgery, and over-treatment with anticoagulants, may have occurred. In Case 2, the guide wire was a possible contributing factor to injuries. In Case 3, the displaced lesser trochanter fragment may have damaged the vessel. Lastly, a drill bit was a contributing factor to the injuries in Case 4.
There are many definitive causes of DFA pseudoaneurysm formation and injuries. Such injuries can be diagnosed via digital subtraction angiography or CT angiography, and a thorough understanding of the anatomy of the femur and damages from reductions is important.
髋部骨折后涉及血管损伤的并发症很少见，股深动脉（DFA）损伤的诊断和处理具有挑战性。我们报告了4例髋部骨折手术后DFA损伤的病例，并旨在探讨其早期发现、治疗及预防方法。
我们回顾了4例髋部骨折后股深动脉损伤的病例。病例1：一名71岁女性假体周围骨折。病例2 - 4：2名男性和1名女性分别发生转子下或转子间骨折。术后通过血管造影发现DFA分支假性动脉瘤形成及损伤。所有患者均被诊断为DFA分支假性动脉瘤形成及损伤。采用经皮介入治疗，用弹簧圈或凝胶封堵假性动脉瘤。
在这些病例中，主要症状为大腿或会阴部剧痛或肿胀并伴有大面积瘀斑。我们使用动脉双功超声诊断假性动脉瘤，并采用血管内介入栓塞治疗损伤。病例1中，可能发生了手术中使用导丝造成的损伤以及抗凝药物的过度治疗。病例2中，导丝可能是造成损伤的一个因素。病例3中，移位的小转子骨折块可能损伤了血管。最后，病例4中钻头是造成损伤的一个因素。
DFA假性动脉瘤形成及损伤有多种确切原因。此类损伤可通过数字减影血管造影或CT血管造影诊断，深入了解股骨解剖结构及复位造成的损伤很重要。
