Moniz M P, Ombrellaro M P, Stevens S L, Freeman M B, Diamond D L, Goldman M H
Department of Surgery, University of Tennessee Medical Center, Knoxville 37920, USA.
Am Surg. 1997 Jan;63(1):24-8.
Lower extremity trauma with concomitant orthopedic and vascular injury is associated with a high degree of limb loss. Despite successful arterial repair, many patients will ultimately require amputations. The effect of associated orthopedic injuries on limb loss in patients with lower extremity arterial injuries is investigated. From 1989 to 1994, 52 infrainguinal arterial injuries were identified among 365 vascular trauma patients. Clinical determinants were retrospectively assessed for the ability to predict postoperative amputations. Femoral artery injuries were present in 23 patients, with 53 per cent the result of blunt trauma. The incidence of lower extremity fractures was 53 per cent (60% open). Seventy-nine per cent of femoral artery injuries were repaired with saphenous vein grafts. Popliteal artery injuries were present in 13 patients, with 77 per cent the result of blunt trauma. The incidence of lower extremity fractures and posterior knee dislocations was 85 per cent (73% open) and 38 per cent, respectively. Ninety-two per cent of injuries were repaired with saphenous vein grafts. Tibial artery injuries were present in 16 patients, with 44 per cent the result of blunt trauma. The incidence of lower extremity fractures was 81 per cent (46% open). Twenty-five per cent of tibial artery injuries were treated with arterial repair, and 31 per cent with arterial ligation. Fourteen above-knee (AKA) and two below-knee amputations were performed. Amputation rates were 26.1 per cent (three AKAs) for femoral, 53.8 per cent (seven AKAs) for popliteal, and 38 per cent (four AKAs, two below-knee amputations) for tibial artery injuries. At the popliteal and femoral locations, greater than two long-bone fractures was predictive of amputation. For tibial arteries, one-vessel (n = 10), two-vessel (n = 3), and three-vessel (n = 3) injuries were associated with 20, 33, and 100 per cent amputations rates, respectively. Blunt injury, pulseless extremity, need for arterial repair (rather than ligation or no therapy), increasing number of injured tibial vessels, and multiple long-bone fractures were predictors of amputation (P < 0.05). Distal vascular injuries combined with complex orthopedic fractures are more likely to result in limb loss. Two or more long-bone fractures is predictive of amputation at all three locations.
伴有骨科和血管损伤的下肢创伤与肢体缺失的高度发生率相关。尽管动脉修复成功，但许多患者最终仍需要截肢。本研究调查了相关骨科损伤对下肢动脉损伤患者肢体缺失的影响。1989年至1994年期间，在365例血管创伤患者中识别出52例腹股沟下动脉损伤。对临床决定因素进行回顾性评估，以预测术后截肢的能力。23例患者存在股动脉损伤，其中53%为钝性创伤所致。下肢骨折的发生率为53%（60%为开放性骨折）。79%的股动脉损伤采用大隐静脉移植修复。13例患者存在腘动脉损伤，其中77%为钝性创伤所致。下肢骨折和膝关节后脱位的发生率分别为85%（73%为开放性骨折）和38%。92%的损伤采用大隐静脉移植修复。16例患者存在胫动脉损伤，其中44%为钝性创伤所致。下肢骨折的发生率为81%（46%为开放性骨折）。25%的胫动脉损伤采用动脉修复治疗，31%采用动脉结扎治疗。共进行了14例膝上截肢（AKA）和2例膝下截肢。股动脉损伤的截肢率为26.1%（3例AKA），腘动脉损伤为53.8%（7例AKA），胫动脉损伤为38%（4例AKA，2例膝下截肢）。在腘动脉和股动脉部位，两处以上长骨骨折可预测截肢。对于胫动脉，单血管损伤（n = 10）、双血管损伤（n = 3）和三血管损伤（n = 3）的截肢率分别为20%、33%和100%。钝性损伤、肢体无脉、需要动脉修复（而非结扎或不治疗）、受伤胫血管数量增加以及多发长骨骨折是截肢的预测因素（P < 0.05）。远端血管损伤合并复杂骨科骨折更易导致肢体缺失。两处或更多处长骨骨折可预测在所有三个部位的截肢。
