Katsamouris A N, Steriopoulos K, Katonis P, Christou K, Drositis J, Lefaki T, Vassilakis S, Dretakis E
Vascular Surgical Unit, University of Crete Medical School, Herakleion University Hospital, Greece.
Eur J Vasc Endovasc Surg. 1995 Jan;9(1):64-70. doi: 10.1016/s1078-5884(05)80227-8.
Review of limb arterial injuries associated with limb fractures.
Retrospective study.
University Hospital.
The clinical presentation, assessment and management of 25 patients with upper (seven) and lower (18) limb arterial injuries associated with limb bone fractures has been retrospectively reviewed.
Five patients presented with life threatening injuries and classic signs of acute limb ischaemia, 15 patients had an obvious limb arterial injury, and 5 presented with a suspected limb arterial injury. The site of arterial damage was: superficial femoral (4); popliteal (11); tibioperoneal trunk (3); anterior tibial (4); posterior tibial (3); peroneal (2); axillary (1); brachial (5); radial (4); and ulnar artery (4). The types of arterial repair were: autogenous vein interposition or bypass grafting (17); P.T.F.E. (2); end-to-end anastomosis (14); and ligation (8). The popliteal vein was injured in six cases, repaired in four and ligated in two; the superficial femoral vein was injured in four cases, repaired in three and ligated in one; and the axillary vein was injured in one case and was ligated. Primary nerve repair was employed in six out of seven injured nerves. Skeletal fixation preceded vascular repair in 21 patients and in four a Javid shunt was used. Intraoperative fasciotomy was performed in 12 out of 18 patients with lower limb ischaemia. Completion arteriography revealed residual thrombi in the distal foot of four patients, in whom intraarterial thrombolysis was effective. During the follow-up period of 1.5 to 2 years, the upper and lower limb preservation rate was 100 and 89%, respectively. The upper limb function was judged excellent in five patients, good in one and fair in one. In the lower limbs it was excellent in 11 patients, good in three, fair in one and poor in one.
To ensure life and functional limb salvage of patients with devastating vascular injuries, a well organised multidisciplinary approach is necessary.
回顾与肢体骨折相关的肢体动脉损伤。
回顾性研究。
大学医院。
回顾性分析25例上肢（7例）和下肢（18例）与肢体骨折相关的动脉损伤患者的临床表现、评估及治疗情况。
5例患者出现危及生命的损伤及急性肢体缺血的典型体征，15例有明显的肢体动脉损伤，5例疑似肢体动脉损伤。动脉损伤部位为：股浅动脉（4例）；腘动脉（11例）；胫腓干（3例）；胫前动脉（4例）；胫后动脉（3例）；腓动脉（2例）；腋动脉（1例）；肱动脉（5例）；桡动脉（4例）；尺动脉（4例）。动脉修复类型为：自体静脉移植或搭桥（17例）；聚四氟乙烯（2例）；端端吻合（14例）；结扎（8例）。6例腘静脉损伤，4例修复，2例结扎；4例股浅静脉损伤，3例修复，1例结扎；1例腋静脉损伤并结扎。7例神经损伤中有6例进行了一期神经修复。21例患者在血管修复前进行了骨骼固定，4例使用了贾维德分流管。18例下肢缺血患者中有12例进行了术中筋膜切开术。血管造影显示4例患者足部远端有残留血栓，动脉内溶栓治疗有效。在1.5至2年的随访期内，上肢和下肢的保肢率分别为100%和89%。上肢功能评定为优5例、良1例、可1例。下肢功能评定为优11例、良3例、可1例、差1例。
为确保严重血管损伤患者的生命及肢体功能挽救，需要一种组织良好的多学科方法。
