Barra J A, Le Saout J, Gaultier Y
J Chir (Paris). 1978 Mar;115(3):151-7.
The authors report four cases of vascular complications of closed injuries of the shoulder, which appeared later, some time after the initial accident. There was one false aneurysm of the axillary artery at the forty sixth day after a fracture of the upper humeral diaphysis with elongation of the brachial plexus; one case of acute ischemia of the upper limb 3 years after a dislocation of the shoulder; one case of thrombosis with gangrene of the hand twelve years after a fracture-dislocation of the head of the humerus and one case of chronic ischemia of the forearm with severe changes in the vessels below one year after a fracture of the clavicle which had caused an aneurysm of the subclavian artery. The clinical, pathological and physiopathological study showed the enormous possibilities of the collateral circulation in the axilla. An arterial lesion may thus remain undiagnosed during the initial trauma. The authors emphasise the importance of the initial examination with a search for disappearance of the peripheral pulses. In the light of these four cases, it seems necessary to explore as a routine any arterial lesion complicating a shoulder injury.
作者报告了4例肩部闭合性损伤的血管并发症，这些并发症均在初次事故后的一段时间出现。其中1例为肱骨干骨折合并臂丛神经牵拉伤后第46天出现腋动脉假性动脉瘤；1例为肩关节脱位3年后出现上肢急性缺血；1例为肱骨头骨折脱位12年后出现手部血栓形成伴坏疽；1例为锁骨骨折导致锁骨下动脉瘤1年后出现前臂慢性缺血且血管有严重改变。临床、病理及病理生理研究显示腋窝侧支循环具有巨大潜力。因此，动脉损伤在初次创伤时可能未被诊断出来。作者强调初次检查时寻找外周脉搏消失情况的重要性。鉴于这4例病例，对于任何并发肩部损伤的动脉病变，似乎有必要常规进行探查。
