O'Malley O, Trompeter A J, Krishnanandan S, Vesely M, Holt P, Goh G, Papadakos N, Bhatia V, Hing C B
Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK.
Department of Radiology, The Alfred Hospital, Melbourne, Australia.
Eur J Orthop Surg Traumatol. 2019 Jul;29(5):1119-1124. doi: 10.1007/s00590-019-02416-4. Epub 2019 Mar 13.
Tibial fractures have an incidence of 15% of all adult fractures. They have been shown to have the highest incidence of non-union in long bone fractures and the highest incidence of vascular injury. Evidence from the literature suggests that a good vascular supply is important to ensure bone union. The aim of our study was to prospectively assess the incidence of vascular injuries in open tibial fractures and determine whether they were associated with an increased risk of non-union.
We performed a prospective study to investigate the incidence of arterial injuries with computed tomography angiography (CTA) in patients with Gustilo-Anderson grade I-III open tibial fractures between 2013 and 2015. CTA was performed with the trauma series at acute admission and reported by two independent musculoskeletal radiologists. Patients were followed up with clinical and radiographic assessment for 1 year.
We recruited 77 patients into the study, and 56 patients (47 males, 9 females) were available for the final analysis, between 16 and 90 years of age. At the initial assessment, 29% had signs of arterial injury with active extravasation in 5%. The most common site of injury was in the diaphysis (87.5%), and the commonest mechanism was a road traffic accident. We found no significant relation between occult vascular injury and non-union (p > 0.05).
The incidence of vascular injury in open tibial fractures is 29%, and CTA is therefore a useful test in identifying vascular injuries that may require vascular intervention.
胫骨骨折占所有成人骨折的15%。在长骨骨折中，胫骨骨折的骨不连发生率最高，血管损伤发生率也最高。文献证据表明，良好的血供对确保骨愈合很重要。我们研究的目的是前瞻性评估开放性胫骨骨折中血管损伤的发生率，并确定它们是否与骨不连风险增加有关。
我们进行了一项前瞻性研究，以调查2013年至2015年间 Gustilo-Anderson I-III级开放性胫骨骨折患者动脉损伤的发生率，采用计算机断层血管造影（CTA）进行评估。在急性入院时用创伤系列进行CTA检查，并由两名独立的肌肉骨骼放射科医生报告结果。对患者进行为期1年的临床和影像学随访评估。
我们招募了77名患者进入研究，最终纳入分析的有56名患者（47名男性，9名女性），年龄在16至90岁之间。在初始评估时，29%的患者有动脉损伤迹象，其中5%有活动性出血。最常见的损伤部位是骨干（87.5%），最常见的致伤机制是道路交通事故。我们发现隐匿性血管损伤与骨不连之间无显著相关性（p>0.05）。
开放性胫骨骨折中血管损伤的发生率为29%，因此CTA是识别可能需要血管干预的血管损伤的有用检查。
