Orthopedics. 2022 Nov-Dec;45(6):340-344. doi: 10.3928/01477447-20220907-02. Epub 2022 Sep 13.
Vascular injury is a feared complication of any surgical procedure. This study examined the incidence of vascular injury during total knee arthroplasty (TKA), the circumstances and timing of injury intraoperatively, and acute management. Eighteen cases of catastrophic vascular injury after primary TKA (12 of 19,577; 0.06%) or revision TKA (6 of 4453; 0.1%) were identified. Catastrophic injury was defined as any vascular injury requiring vascular surgery. Chart review was performed to identify the timing of vascular injury, the injured blood vessel, and acute management. The Knee Society Score (KSS) was calculated. Mean follow-up was 8 years. Surgical indications included primary osteoarthritis for 12 cases, reimplantation for infection for 3 cases, and aseptic revision for 3 cases. Vessel injury included the popliteal artery in 10 cases, the popliteal artery and vein in 5 cases, and the popliteal vein in 3 cases. Thirteen injuries occurred during tibial preparation. Management included thrombectomy and reanastomosis in 15 cases and vessel bypass in 3 cases. One patient had thrombosis and limb ischemia 2 days after repair, requiring bypass. No amputations had occurred at late follow-up. Mean KSS was 74 at latest follow-up. Catastrophic vascular injury is more common after revision TKA (1 of 1000) than after primary TKA (6 of 10,000). Most injuries occur during tibial preparation. If identified quickly and addressed promptly by vascular surgery, limb salvage is likely. [. 2022;45(6):340-344.].
血管损伤是任何外科手术都害怕发生的并发症。本研究检查了全膝关节置换术（TKA）过程中血管损伤的发生率、术中损伤的情况和时间以及急性处理。在初次 TKA（19577 例中的 12 例，0.06%）或翻修 TKA（4453 例中的 6 例，0.1%）后发现了 18 例灾难性血管损伤。灾难性损伤定义为需要血管手术的任何血管损伤。通过病历回顾确定血管损伤的时间、损伤的血管和急性处理。计算了膝关节协会评分（KSS）。平均随访 8 年。手术指征包括原发性骨关节炎 12 例，感染再植入 3 例，无菌翻修 3 例。血管损伤包括 10 例腘动脉、5 例腘动静脉和 3 例腘静脉。13 例损伤发生在胫骨准备过程中。处理方法包括血栓切除术和再吻合术 15 例，血管旁路术 3 例。1 例患者在修复后 2 天发生血栓形成和肢体缺血，需要旁路。晚期随访无截肢。末次随访平均 KSS 为 74。翻修 TKA 后灾难性血管损伤更常见（1/1000），而初次 TKA 后则较少见（6/10000）。大多数损伤发生在胫骨准备过程中。如果能快速识别并由血管外科及时处理，肢体保存的可能性较大。[。2022 年；45（6）：340-344。]。
