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[前交叉韧带重建术后罕见的血管并发症]

[Rare Vascular Complication after ACL Reconstruction].

作者信息

Hanus M, HudÁk R

机构信息

Klinika dětské a dospělé ortopedie a traumatologie 2. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha.

出版信息

Acta Chir Orthop Traumatol Cech. 2020;87(6):452-455.

Abstract

The anterior cruciate ligament reconstruction is currently one of the most commonly performed arthroscopic procedures of knee joint. Overall, it is a reliable and sophisticated procedure associated with a relatively low complication rate. In the available literature, less severe complications are reported in 3-7% of cases. The most frequent complications are intractable pain not manageable using analgesic therapy (6.7%), hemarthrosis requiring puncture (4.4%), fever (3.2%) and other complications related in particular to immobilisation (1.2%). The percentage of severe complications is very low (less than 1%). These include deep vein thrombosis (0.6%), cellulitis (0.6%) and infectious complications requiring arthroscopic or surgical revision (0.3%). Vascular injuries around the knee joint are rare and are described in case studies only. The authors present a patient with reduced mobility of the knee and significant pain, haematoma and swelling in the calf, which developed within a short time span after the reconstruction of anterior cruciate ligament. It was caused by bleeding into the medial gastrocnemius muscle. This rare vascular complication was diagnosed angiographically and coiling was used to stop the arterial bleeding, once deep vein thrombosis, congenital haemostasis, gonitis and compartment syndrome were excluded. Key words: ACL reconstruction, angiography, anterior cruciate ligament, arthroscopy, inferior medial genicular artery, vascular complications.

摘要

前交叉韧带重建术是目前最常进行的膝关节关节镜手术之一。总体而言,这是一种可靠且复杂的手术,并发症发生率相对较低。在现有文献中,3% - 7%的病例报告了不太严重的并发症。最常见的并发症是使用镇痛疗法无法控制的顽固性疼痛(6.7%)、需要穿刺的关节积血(4.4%)、发热(3.2%)以及其他特别是与固定相关的并发症(1.2%)。严重并发症的比例非常低(不到1%)。这些包括深静脉血栓形成(0.6%)、蜂窝织炎(0.6%)以及需要关节镜或手术翻修的感染性并发症(0.3%)。膝关节周围的血管损伤很罕见,仅在病例研究中有描述。作者介绍了一名患者,在前交叉韧带重建术后短时间内出现膝关节活动度降低、小腿明显疼痛、血肿和肿胀。这是由内侧腓肠肌出血引起的。在排除深静脉血栓形成、先天性止血、膝关节炎和骨筋膜室综合征后,通过血管造影诊断出这种罕见的血管并发症,并采用弹簧圈栓塞来止住动脉出血。关键词:前交叉韧带重建;血管造影;前交叉韧带;关节镜检查;膝下内侧动脉;血管并发症

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