Dart C H, Braitman H E
Arch Surg. 1977 Aug;112(8):969-73. doi: 10.1001/archsurg.1977.01370080067011.
Fracture dislocations or dislocations of the knee can produce an arterial injury that may be difficult to evaluate clinically. Aggressive diagnosis and treatment can produce satisfactory results in both vascular and orthopedic situations if performed early after the injury. Five cases of popliteal arterial injury were seen from April 1974 to August 1976. Three cases were following posterior knee dislocation, one was a femoral fracture displacement, and one was a rotary tibiofibular displacement. Four of the patients had complete popliteal artery transection and one had intramural hematoma and spasm. Initial diagnosis of severe arterial injury, although suspicious on clinical grounds, was not conclusive. Use of a Doppler flowmeter and arteriography was essential for the diagnosis of arterial injury. Peroneal nerve injury was present in two of five patients. Vascular surgery was successful in all cases. Skeletal instability was corrected at the time of vascular exploration, usually through same incision. Leg compartment edema or hematoma was common, but responded to fasciotomy in all cases. Vein graft reconstruction was preferred to direct repair because of wall contusion and the need for additional vessel length over edematous and contused tissue. Acceptable knee stability was obtained from initial repair in all cases.
膝关节骨折脱位或脱位可导致动脉损伤，临床上可能难以评估。如果在受伤后早期进行积极的诊断和治疗，在血管和骨科情况中都能产生满意的结果。1974年4月至1976年8月期间共见到5例腘动脉损伤病例。其中3例发生于膝关节后脱位后，1例为股骨骨折移位，1例为胫腓骨旋转移位。5例患者中有4例腘动脉完全横断，1例有壁内血肿和痉挛。尽管临床上怀疑有严重动脉损伤，但初步诊断并不明确。使用多普勒流量计和动脉造影对诊断动脉损伤至关重要。5例患者中有2例存在腓总神经损伤。所有病例血管手术均成功。血管探查时通常通过同一切口纠正骨骼不稳定。腿部筋膜室水肿或血肿很常见，但所有病例均对筋膜切开术有反应。由于血管壁挫伤以及需要在水肿和挫伤组织上增加血管长度，静脉移植重建优于直接修复。所有病例通过初次修复均获得了可接受的膝关节稳定性。
