Lim L T, Michuda M S, Flanigan D P, Pankovich A
Arch Surg. 1980 Nov;115(11):1307-13. doi: 10.1001/archsurg.1980.01380110045007.
Injury to the popliteal artery is the most common cause of amputation in injured extremities. A six-year experience (1974-1979) at Cook County Hospital, Chicago, involved 31 popliteal artery injuries without amputation. Penetrating trauma was the most frequent cause of injury; however, a considerable number of blunt trauma injuries with fractures and dislocations were also present. Prolonged ischemic time was not a deterrent to successful vascular reconstruction. The recognition of compartmental hypertension and performance of fasciotomy before vascular repair were credited as major factors in our success. The use of interposition saphenous vein graft in the arterial reconstruction, repair of concomitant popliteal vein injuries, initial bone fixation of fractures with external fixators, and the performance of intraoperative arteriography were all important steps taken to ensure a 100% limb salvage.
腘动脉损伤是四肢损伤中截肢最常见的原因。芝加哥库克县医院六年(1974 - 1979年)的经验涉及31例未行截肢的腘动脉损伤。穿透性创伤是最常见的损伤原因;然而,也存在相当数量伴有骨折和脱位的钝性创伤损伤。缺血时间延长并非成功进行血管重建的阻碍。认识到骨筋膜室高压并在血管修复前进行筋膜切开术被认为是我们成功的主要因素。在动脉重建中使用大隐静脉移植、修复伴随的腘静脉损伤、用外固定器对骨折进行初期固定以及术中进行动脉造影都是为确保100%保肢而采取的重要步骤。