Chitwood W R, Rankin J S, Bollinger R R, Moylan J A
Surgery. 1981 Mar;89(3):355-8.
Fracture stabilization is often desirable prior to vascular repair in the management of major extremity injuries. This principle is particularly important when long vein grafts are required to minimize the risk of anastomotic disruption during the orthopedic portion of the procedure. However, in situations associated with prolonged periods of preoperative ischemia, early reperfusion of the injured extremity would be optimal. This report illustrates two cases of brachial artery injury in which heparin-bonded shunts were used to establish blood flow to the distal extremity before fracture fixation. The shunts were interposed between disrupted arterial segments and reestablished distal perfusion while associated fractures were internally stabilized. Thus, early revascularization allowed the orthopedic repair to proceed in an unhurried fashion. After adequate stabilization of the fracture, arterial reconstruction was completed using saphenous vein interposition grafts. This technique potentially could improve extremity salvage rates and facilitate the repair of arterial injuries associated with unstable long bone fractures.
在处理严重肢体损伤时，通常希望在血管修复之前实现骨折稳定。当需要使用长静脉移植物以尽量降低手术骨科部分吻合口破裂风险时，这一原则尤为重要。然而，在与术前长时间缺血相关的情况下，早期恢复受伤肢体的血供是最佳选择。本报告阐述了两例肱动脉损伤病例，其中在骨折固定之前使用肝素结合分流管来建立远端肢体的血流。分流管置于中断的动脉段之间，重建远端灌注，同时对相关骨折进行内固定。因此，早期血管重建使得骨科修复能够从容进行。在骨折充分固定后，使用大隐静脉移植完成动脉重建。该技术有可能提高肢体挽救率，并便于修复与不稳定长骨骨折相关的动脉损伤。
