Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
J Surg Res. 2021 Sep;265:159-167. doi: 10.1016/j.jss.2021.03.039. Epub 2021 Apr 30.
The femoral artery is commonly injured following lower extremity trauma. If not identified early and addressed properly, it can lead to compartment syndrome (CS) and limb amputation. The aim of this study is to examine traumatic femoral artery injuries and identify risk factors for the development of lower extremity CS.
Adult (≥18 years) patients who presented with traumatic femoral artery injuries were identified in the Trauma Quality Improvement Program 2017. Patients were stratified into two groups, those with evidence of lower extremity compartment syndrome (CS) and those without CS (NCS), for comparison. Multivariate regression analysis was performed.
A total of 1,297 adult trauma patients with femoral artery injury were identified. Mean age was 36 ± 15 y, 86% were male, and 68% had penetrating injuries. Median extremity abbreviated injury scale (AIS) was 3 [3,4], and median injury severity score (ISS) was 27 [22-41]. 68 (5.2%) patients were diagnosed with CS of the lower extremity, 66 (97.1%) of those patients underwent fasciotomy and one (1.5%) patient eventually had an amputation. On multivariate regression analysis, concomitant femoral vein, femoral nerve, and popliteal artery injuries and early need for blood transfusions were independent risk factors for the development of CS (OR 3.1, 3.8, 4.3, and 2.5 respectively).
CS following traumatic femoral artery injury is a relatively common finding. Physicians must maintain a high index of suspicion and should consider prophylactic fasciotomy in the setting of combined femoral vein and nerve injuries, combined popliteal artery injury, and multiple blood transfusions.
下肢创伤后常导致股动脉损伤。如果不能早期发现并正确处理，可能导致筋膜间室综合征（CS）和肢体截肢。本研究旨在探讨外伤性股动脉损伤，并确定发生下肢 CS 的危险因素。
在 2017 年创伤质量改进计划中确定了外伤性股动脉损伤的成年（≥18 岁）患者。将患者分为两组，一组有下肢 CS 证据（CS 组），一组无 CS（非 CS 组）进行比较。进行多变量回归分析。
共确定了 1297 例成年创伤性股动脉损伤患者。平均年龄为 36 ± 15 岁，86%为男性，68%为穿透性损伤。四肢损伤严重程度评分（AIS）中位数为 3 [3,4]，损伤严重程度评分（ISS）中位数为 27 [22-41]。68（5.2%）例患者被诊断为下肢 CS，其中 66（97.1%）例患者行筋膜切开术，1（1.5%）例患者最终截肢。多变量回归分析显示，股静脉、股神经和腘动脉同时损伤以及早期需要输血是 CS 发生的独立危险因素（OR 分别为 3.1、3.8、4.3 和 2.5）。
外伤性股动脉损伤后 CS 较为常见。医生必须保持高度警惕，对于股静脉和神经同时损伤、股动脉同时损伤以及多次输血的患者，应考虑预防性筋膜切开术。
