Devendra Agraharam, Avinash M, Chidambaram Dinesh, Dheenadhayalan Jayaramaraju, Rajasekaran S
Department of Orthopaedic Surgery, Ganga Hospital, Coimbatore, India.
J Orthop Surg (Hong Kong). 2018 Jan-Apr;26(1):2309499018762616. doi: 10.1177/2309499018762616.
The cerclage passer instrument was introduced for aiding percutaneous reduction in spiral femur fractures, thereby overcoming the risk of devascularization of the fracture ends commonly associated with traditional open cerclage wiring techniques. This may, however, predispose to iatrogenic vascular injuries owing to the proximity of the vessels and several other factors. We report four cases with femoral artery (superficial and deep) injuries caused by the cerclage passer in proximal femur and distal femur shaft fractures and incidence of these injuries in our institution.
Retrospective analysis of hospital records of femoral fractures from 2011 to 2015. All cases of femoral fractures and periprosthetic femoral fractures with cerclage wiring done using the standard or the Synthes cerclage passer were included. Cases with wiring done for trochanteric fractures and other locations were excluded.
Incidence of vascular injuries due to the cerclage passer in proximal femur shaft fractures was 1.59%, whereas in distal femur shaft fractures it was 7.14%. There were two patients with a deep femoral artery (DFA) system injury and two with a superficial femoral artery (SFA) injury caused by the cerclage passer (Synthes) in two proximal femur shaft and two distal femur shaft fractures, respectively. End-to-end anastomosis for the SFA and ligation for DFA system injuries were used, with an uneventful postoperative period in all patients.
Caution and accuracy is imperative to avoid vascular injuries while using the cerclage passer in femur fractures, and strict vigilance is essential for early identification and prompt management.
环扎器被用于辅助经皮复位股骨螺旋骨折，从而克服传统切开环扎钢丝技术通常所伴有的骨折端血管化风险。然而，由于血管位置靠近以及其他一些因素，这可能会导致医源性血管损伤。我们报告了4例因环扎器导致的股骨近端和远端骨折中股动脉（浅支和深支）损伤的病例以及这些损伤在我们机构中的发生率。
对2011年至2015年股骨骨折的医院记录进行回顾性分析。纳入所有使用标准或辛迪思环扎器进行环扎钢丝固定的股骨骨折和股骨假体周围骨折病例。排除转子间骨折和其他部位进行钢丝固定的病例。
股骨近端骨折中环扎器导致血管损伤的发生率为1.59%，而在股骨远端骨折中为7.14%。分别有2例股骨近端骨折和2例股骨远端骨折因环扎器（辛迪思）导致股深动脉（DFA）系统损伤和2例股浅动脉（SFA）损伤。对SFA进行端端吻合，对DFA系统损伤进行结扎，所有患者术后恢复顺利。
在股骨骨折中使用环扎器时，必须小心谨慎且操作精确以避免血管损伤，严格警惕对于早期识别和及时处理至关重要。
