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钝性下肢创伤合并血管损伤保肢失败的预测因素

Predictive Factors for Failure of Limb Salvage in Blunt Leg Trauma Associated with Vascular Injuries.

作者信息

Al-Zoubi Nabil A, Shatnawi Nawaf J, Khader Yousef, Heis Mowafeq, Aleshawi Abdelwahab J

机构信息

Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan.

Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan.

出版信息

J Emerg Trauma Shock. 2021 Apr-Jun;14(2):80-85. doi: 10.4103/JETS.JETS_37_20. Epub 2021 Jun 25.

Abstract

INTRODUCTION

Blunt leg trauma is common; however, it is rarely associated with significant vascular injury. This study was undertaken to determine the risk factors attributed to failure of limb salvage in acute postoperative period in blunt leg trauma with vascular injuries after revascularization.

METHODS

A retrospective analysis was conducted of all patients with blunt leg trauma involving bone and soft tissue associated with vascular injuries. They were studied in terms of demographic data, associated comorbidities, mechanism of trauma, associated extra leg injuries, type and nature of bone fractures, soft-tissue injuries, nerve injuries, time of ischemia, Injury Severity Score (ISS), Mangled Extremity Severity Score (MESS), injured vascular segments, modality of vascular repair, modality of bone fixation, thrombosis at the site of vascular repair, complications, limb salvage failure, and mortality.

RESULTS

Vascular injuries were identified in 45 arterial segments and 9 popliteal veins among 31 patients. The patients were 93% male, with a mean age of 31 years. The MESS ranged from 6 to 11, and the ISS ranged from 9 to 41. The main pathology of the injured vessels was contusion/thrombosis in 28 legs, which were repaired by interposition-reversed long saphenous vein graft. Seven patients developed postoperative thrombosis and underwent thrombectomy/embolectomy. Failure of limb salvage occurred in seven limbs with no mortality.

CONCLUSIONS

Severe multi-segmental bone fractures, prolong ischemic time of >10 h, and MESS of ≥9 are significant predictors of limb loss in patients with blunt leg trauma in association with vascular injuries.

摘要

引言

钝性下肢创伤很常见;然而,它很少与严重的血管损伤相关。本研究旨在确定钝性下肢创伤伴血管损伤血管再通术后急性术后肢体挽救失败的危险因素。

方法

对所有伴有血管损伤的钝性下肢创伤累及骨骼和软组织的患者进行回顾性分析。研究内容包括人口统计学数据、合并症、创伤机制、下肢以外的相关损伤、骨折类型和性质、软组织损伤、神经损伤、缺血时间、损伤严重程度评分(ISS)、肢体损伤严重程度评分(MESS)、受伤血管节段、血管修复方式、骨固定方式、血管修复部位的血栓形成、并发症、肢体挽救失败和死亡率。

结果

31例患者中,共发现45条动脉节段和9条腘静脉血管损伤。患者93%为男性,平均年龄31岁。MESS范围为6至11,ISS范围为9至41。受伤血管的主要病理改变为28条腿的挫伤/血栓形成,采用大隐静脉倒置移植修复。7例患者术后发生血栓形成并接受了血栓切除术/栓子切除术。7条肢体挽救失败,无死亡病例。

结论

严重的多节段骨折、缺血时间延长>10小时以及MESS≥9是钝性下肢创伤伴血管损伤患者肢体丢失的重要预测因素。

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