胫骨股骨创伤后钝性腘动脉损伤：血管优先与骨优先策略。
Blunt popliteal artery injury following tibiofemoral trauma: vessel-first and bone-first strategy.
机构信息
Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, 55 Fruit Street, Boston, USA.
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
出版信息
Eur J Trauma Emerg Surg. 2022 Apr;48(2):1045-1053. doi: 10.1007/s00068-021-01632-0. Epub 2021 Mar 20.
PURPOSE
Blunt popliteal artery injury (BPAI) is a potentially limb-threatening sequela of tibiofemoral (knee) dislocations and fractures. Associated amputation rates for all popliteal artery (PA) injuries range between 10 and 50%. It is unclear whether PA repair or bone stabilization should be performed first. We analyzed (long-term) clinical outcomes of BPAI patients that received initial PA repair (vessel-first, VF) versus initial external stabilization (bone-first, BF).
METHODS
Retrospectively, all surgically treated BPAI patients between January 2000 and January 2019, admitted to two level 1 trauma centers were included. Clinical outcomes were determined, stratified by initial management strategy (VF and BF). Treatment strategy was determined by surgeon preference, based on associated injuries and ischemia duration. Primary outcomes (amputation and mortality) and secondary outcomes (claudication and complications) were determined.
RESULTS
Of 27 included BPAI patients, 15 were treated according to the VF strategy (56%) and 12 according to the BF strategy (44%). Occlusion was the most frequently encountered BPAI in 18/27 patients (67%). Total delay and in-hospital delay were comparable between groups (p = 1.00 and p = 0.82). Revascularization was most frequently performed by PA bypass (59%). All patients had primary limb salvage during admission (100%). One secondary amputation due to knee pain was performed in the BF group (4%). During a median clinical follow-up period of 2.7 years, three PA re-interventions were performed, two in the BF group and one in the VF group. None suffered from (intermittent) claudication.
CONCLUSION
Blunt popliteal artery injury (BPAI) is a rare surgical emergency. Long-term outcomes of early revascularization for BPAI appear to be good, independent of initial management strategy. The BF strategy may be preferred in case of severe orthopedic injury, if allowed by total ischemia duration.
目的
钝性腘动脉损伤（BPAI）是膝关节脱位和骨折潜在的危及肢体的后遗症。所有腘动脉（PA）损伤的截肢率在 10%至 50%之间。目前尚不清楚是先进行 PA 修复还是先进行骨稳定。我们分析了接受初始 PA 修复（血管优先，VF）与初始外部稳定（骨优先，BF）的 BPAI 患者的（长期）临床结果。
方法
回顾性纳入 2000 年 1 月至 2019 年 1 月期间在两家 1 级创伤中心接受手术治疗的所有 BPAI 患者。根据初始治疗策略（VF 和 BF）对临床结果进行分层。治疗策略由外科医生根据伴随损伤和缺血持续时间的偏好决定。确定了主要结局（截肢和死亡率）和次要结局（跛行和并发症）。
结果
在 27 例 BPAI 患者中，15 例（56%）按 VF 策略治疗，12 例（44%）按 BF 策略治疗。18/27 例患者（67%）最常发生 PA 闭塞。两组总延迟和住院延迟无差异（p=1.00 和 p=0.82）。再血管化最常通过 PA 旁路进行（59%）。所有患者在住院期间均实现了原发性肢体挽救（100%）。1 例 BF 组因膝关节疼痛行二次截肢（4%）。在 2.7 年的中位临床随访期间，BF 组和 VF 组各进行了 2 次和 1 次 PA 再介入，均无间歇性跛行。
结论
钝性腘动脉损伤（BPAI）是一种罕见的外科急症。BPAI 早期血运重建的长期结果似乎较好，与初始治疗策略无关。如果总缺血时间允许，BF 策略在严重骨科损伤时可能更为优先。
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