Iannacone W M, Taffet R, DeLong W G, Born C T, Dalsey R M, Deutsch L S
Division of Orthopaedic Surgery, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden.
J Trauma. 1994 Sep;37(3):446-51. doi: 10.1097/00005373-199409000-00020.
Fracture of the femur with accompanying arterial injury represents approximately 1% of all femoral fractures. Controversy exists regarding the choice of fixation and the sequence of fixation and vascular repair. We report on the treatment of six patients with seven distal femoral fractures and angiographically documented arterial injuries treated over a 20-month period. The treatment protocol consisted of angiography followed by provisional external fixation and early primary exchange to an intramedullary nail. Five of the seven fractures were open. Three fractures were caused by blunt trauma, and four were secondary to shotgun blasts. Average follow-up was 12 months (range, 6-25 months). All fractures healed with an average time to union of 25 weeks. There were no complications related to the vascular repair. One case of an acute deep infection resolved after debridement and placement of polymethylmethacrylate cement beads impregnated with antibiotics and a course of intravenous antibiotics. All patients returned to their previous levels of activity. Based on the results of our experience with a small group of patients, we feel that this treatment protocol will prove to be a safe and efficient method of management of these difficult injuries.
股骨骨折伴动脉损伤约占所有股骨骨折的1%。关于固定方式的选择以及固定与血管修复的顺序存在争议。我们报告了在20个月期间对6例患者的7处股骨远端骨折及血管造影证实的动脉损伤的治疗情况。治疗方案包括血管造影，随后进行临时外固定，并早期一期更换为髓内钉。7处骨折中有5处为开放性骨折。3处骨折由钝器伤引起，4处继发于猎枪爆炸伤。平均随访时间为12个月（范围6 - 25个月）。所有骨折均愈合，平均愈合时间为25周。未出现与血管修复相关的并发症。1例急性深部感染经清创、植入含抗生素的聚甲基丙烯酸甲酯骨水泥珠及静脉使用抗生素疗程后痊愈。所有患者均恢复到先前的活动水平。基于我们对一小群患者的经验结果，我们认为该治疗方案将被证明是治疗这些复杂损伤的一种安全有效的方法。
