Department of Orthopaedics, Trauma and Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, Tamil Nadu, 313, Mettupalayam Road, Coimbatore, 641 043, India.
Department of Plastic Surgery and Microsurgery, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, India.
Eur J Trauma Emerg Surg. 2022 Feb;48(1):637-645. doi: 10.1007/s00068-020-01546-3. Epub 2020 Nov 23.
Purpose of this study was to report the etiology, diagnosis, surgical management, and outcome of pseudoaneurysm associated with orthopedic trauma.
A retrospective review was conducted of all patients presenting to a Level 1 trauma center between 2013 and 2019. Clinical records were reviewed for the mechanism of primary injury, associated fracture pattern, time of presentation, site of involvement, etiology of the pseudoaneurysm, diagnosis, management, and complications. We identified 14 patients with pseudoaneurysm of peripheral arteries following orthopedic trauma.
The mean interval between primary injury and the manifestation of clinical symptoms was 88.5 days (range, 16-304 days). There were 3 upper limb injuries and 11 lower limb injuries. The presenting symptoms were pain associated with excessive extremity swelling in most of the patients. A significant drop in hemoglobin (mean fall- 2.9 g/dL) was noted in nine patients. Most common artery involved was the superficial branch of femoral artery and posterior tibial artery followed by the brachial artery. Fractured bone spike was the cause of injury in eight patients and iatrogenic injury in six patients. Diagnosis was confirmed by CT angiography with duplex scan in eight patients, duplex scan alone in one patient, MRI along with duplex scan in one patient. The remaining four patients were diagnosed intraoperatively. Excision of the pseudoaneurysm and ligation of the involved minor arteries was done in eight patients. Surgical repair of the major artery with critical vascular injury was done in six patients. One patient underwent secondary amputation following the anastomotic blowout.
Early diagnosis of pseudoaneurysm requires knowledge and a high index of suspicion. Surgical reconstruction of major arteries should always be done and ligation of major vessels can lead to catastrophes. Excision of pseudoaneurysm can be done when minor arteries are involved with the presence of good collateral circulation.
Level IV Study.
本研究旨在报告与骨科创伤相关的假性动脉瘤的病因、诊断、手术治疗和结果。
对 2013 年至 2019 年期间在一家 1 级创伤中心就诊的所有患者进行了回顾性分析。对临床记录进行了回顾，以了解原发性损伤的机制、相关骨折类型、就诊时间、受累部位、假性动脉瘤的病因、诊断、治疗和并发症。我们共确定了 14 例因骨科创伤引起的外周动脉假性动脉瘤患者。
初次损伤和出现临床症状之间的平均间隔时间为 88.5 天（范围为 16-304 天）。上肢损伤 3 例，下肢损伤 11 例。大多数患者的主要症状为疼痛伴患肢过度肿胀。9 例患者的血红蛋白显著下降（平均下降 2.9 g/dL）。最常见受累的动脉是股浅动脉和胫后动脉的分支，其次是肱动脉。8 例患者的损伤原因是骨折骨尖，6 例患者是医源性损伤。8 例患者通过 CT 血管造影联合双功超声确诊，1 例患者仅通过双功超声确诊，1 例患者通过 MRI 联合双功超声确诊。其余 4 例患者在术中确诊。8 例患者行假性动脉瘤切除及受累小动脉结扎术，6 例患者行主要动脉修复伴严重血管损伤。1 例患者吻合口爆裂后行二期截肢。
假性动脉瘤的早期诊断需要具备相关知识并保持高度警惕。始终应进行主要动脉的重建手术，结扎主要血管可能导致灾难性后果。当存在良好的侧支循环时，可以对小动脉受累的假性动脉瘤进行切除。
IV 级研究。
