Ge Jun, Kong Ke-Yu, Cheng Xiao-Qiang, Li Peng, Hu Xing-Xing, Yang Hui-Lin, Shen Min-Jie
Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China.
World J Clin Cases. 2020 Jul 6;8(13):2862-2869. doi: 10.12998/wjcc.v8.i13.2862.
Vascular injury is a rare complication of femoral shaft fractures, and rupture of the deep femoral artery is more difficult to diagnose because of its anatomical location and symptoms. Despite its low incidence, deep femoral artery rupture can lead to life-threatening outcomes, such as compartment syndrome, making early identification and diagnosis critical.
A 45-year-old male patient was admitted to our hospital due to right lower limb trauma in a car accident, with complaints of severe pain and swelling on his right thigh. X-ray demonstrated a right femoral shaft fracture. During preparation for emergency surgery, his blood pressure and blood oxygen saturation dropped, and sensorimotor function was lost. Computed tomography angiography was performed immediately to confirm the diagnosis of rupture of the deep femoral artery and compartment syndrome, so fasciotomy and vacuum-assisted closure were performed. Rhabdomyolysis took place after the operation and the patient was treated with appropriate electrolyte correction and diuretic therapy. Twenty days after the fasciotomy, treatment with the Hoffman Type II External Fixation System was planned, but it was unable to be immobilized internally based on a new esophageal cancer diagnosis. We kept the external fixation for 1 year, and 3 years of follow-up showed improvement of the patient's overall conditions and muscle strength.
For patients with thigh swelling, pain, anemia, and unstable vital signs, anterior femoral artery injury should be highly suspected. Once diagnosed, surgical treatment should be performed immediately and complications of artery rupture must be suspected and addressed in time.
血管损伤是股骨干骨折罕见的并发症，由于其解剖位置和症状，股深动脉破裂更难诊断。尽管其发病率低，但股深动脉破裂可导致危及生命的后果，如骨筋膜室综合征，因此早期识别和诊断至关重要。
一名45岁男性患者因车祸致右下肢外伤入院，主诉右大腿剧痛、肿胀。X线显示右股骨干骨折。在准备急诊手术期间，其血压和血氧饱和度下降，感觉运动功能丧失。立即进行计算机断层血管造影以确诊股深动脉破裂和骨筋膜室综合征，随后进行了筋膜切开减压术和负压封闭引流术。术后发生横纹肌溶解，对患者进行了适当的电解质纠正和利尿治疗。筋膜切开术后20天，计划采用霍夫曼II型外固定系统治疗，但因新诊断出食管癌而无法进行内固定。我们采用外固定治疗1年，3年随访显示患者整体状况和肌肉力量有所改善。
对于大腿肿胀、疼痛、贫血且生命体征不稳定的患者，应高度怀疑股前动脉损伤。一旦确诊，应立即进行手术治疗，必须及时怀疑并处理动脉破裂的并发症。
