体重指数在导致膝关节损伤伴腘动脉损伤的高、低能创伤中的作用。
The role of body mass index in high- and low-velocity trauma causing knee injury associated with popliteal artery lesions.
机构信息
Unit of Vascular Surgery, Biomedicine and Prevention Department, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
Orthopedic and Traumatology Unit, Surgical Sciences Department, University of Rome Tor Vergata, Rome, Italy.
出版信息
J Orthop Surg Res. 2024 Jun 10;19(1):347. doi: 10.1186/s13018-024-04821-w.
BACKGROUND
Among arterial traumas, osteoarticular traumas are particularly dangerous, and those involving the popliteal artery are associated with a high amputation rate. Despite representing a minority of arterial traumas, with an incidence that varies considerably by population and geographic location, traumatic lesions of the popliteal artery are challenging. This study aimed to verify the impact of body mass index (BMI) on arterial trauma damage and patient outcomes.
METHODS
Data were retrospectively collected from the electronic medical reports of all patients with osteoarticular and vascular associated lesions treated in the emergency operating room at our institution between 1 January 2005 and 1 May 2022. Forty-one patients presented with lower limb arterial trauma (43.2%); popliteal artery lesions occurred in 11 of these patients (26.8%), who were eligible for inclusion in the study. The lesion mechanism was dislocation by high-velocity trauma in 9 patients and dislocation by low-velocity trauma in 3 patients. All 7 males (63.6%) experienced high-velocity trauma, and 2 of the 3 females experienced low-velocity trauma. Only one patient had an isolated popliteal artery lesion associated with fractures in the leg or the contralateral limb. Patients with low-velocity trauma were older than 54 years, while those with high-velocity trauma were aged 22 to 71 years.
RESULTS
In 10/11 patients (90.9%), revascularization was performed after osteoarticular stabilization and reduction of the dislocation or fracture. Intraoperative angiography was selectively used. Two patients required above-the-knee amputation after the procedure: one due to infection of the surgical access point and the other due to severe soft tissue injury. One patient died during hospitalization due to trauma-related complications and comorbidities.
CONCLUSIONS
High-velocity trauma and low-velocity trauma in patients with a body mass index > 35 kg/m and knee lesions are associated with popliteal artery lesions. Revascularization success is not associated with high- or low-velocity trauma.
背景
在动脉创伤中，骨关节创伤尤其危险，而涉及腘动脉的创伤则与高截肢率相关。尽管创伤性腘动脉损伤在所有动脉创伤中占比较小，但其发病率因人群和地理位置的不同而有很大差异，仍然具有挑战性。本研究旨在验证体重指数（BMI）对动脉创伤损伤和患者结局的影响。
方法
本研究回顾性收集了 2005 年 1 月 1 日至 2022 年 5 月 1 日期间在我院急诊手术室治疗的所有骨关节和血管相关病变患者的电子病历数据。41 例患者出现下肢动脉创伤（43.2%）；其中 11 例（26.8%）患者出现腘动脉病变，符合纳入本研究的条件。损伤机制为 9 例高能量创伤所致的脱位和 3 例低能量创伤所致的脱位。7 例男性（63.6%）均为高能量创伤，3 例女性中有 2 例为低能量创伤。仅有 1 例患者存在孤立性腘动脉损伤，同时伴有腿部或对侧肢体骨折。低能量创伤患者年龄大于 54 岁，而高能量创伤患者年龄为 22 至 71 岁。
结果
11 例患者中有 10 例（90.9%）在骨关节复位和脱位或骨折固定后进行了血运重建。术中选择性使用了血管造影。2 例患者在手术后需要进行膝上截肢：1 例因手术入路点感染，另 1 例因严重软组织损伤。1 例患者因创伤相关并发症和合并症在住院期间死亡。
结论
BMI＞35kg/m 的患者中，高能量创伤和低能量创伤合并膝关节病变与腘动脉损伤相关。血运重建的成功与高能量或低能量创伤无关。
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