Harrell D J, Spain D A, Bergamini T M, Miller F B, Richardson J D
Department of Surgery, University of Louisville, Kentucky 40292, USA.
Am Surg. 1997 Mar;63(3):228-31; discussion 231-2.
Blunt popliteal artery trauma is a challenging injury, particularly when associated with major soft tissue damage. We reviewed our experience with this injury to determine 1) the incidence of vascular injury associated with fractures and/or dislocations about the knee, 2) the incidence of limb loss, and 3) factors associated with amputation. We treated 37 patients with 38 blunt popliteal artery injuries and either fractures about the knee or posterior knee dislocations. Patients who underwent primary amputations were excluded. The incidence of popliteal artery injuries with fractures about the knee was 3 per cent, whereas 16 per cent of patients with posterior knee dislocations had vascular injuries (P < 0.05). Amputations were required in 14 of the 38 injured limbs (36%). None of these patients had a pulse or Doppler signal on admission, and 13 had major soft tissue injury. No patient with a pulse or Doppler signal lost a limb (P < 0.05). Limb loss was primarily related to limited venous outflow and/or severe infection in damaged tissue. Failure of the arterial repair rarely led to amputation, particularly in recent years. Two patients with angiographically proven arterial injuries were treated nonoperatively without complications. The incidence of vascular injuries associated with fractures about the knee is low, but somewhat higher with posterior knee dislocations. The overall 9 per cent rate of positive angiograms suggests that a selective approach may be indicated. The amputation rate remains high, but it has improved with an integrated, multidisciplinary team approach. In patients without a pulse or Doppler signal and with severe soft tissue injuries, primary amputation may be appropriate.
腘动脉钝性损伤是一种具有挑战性的损伤，尤其是当伴有严重软组织损伤时。我们回顾了我们在这种损伤方面的经验，以确定：1）与膝关节周围骨折和/或脱位相关的血管损伤发生率；2）肢体缺失的发生率；3）与截肢相关的因素。我们治疗了37例患者，共发生38例腘动脉钝性损伤，同时伴有膝关节周围骨折或膝关节后脱位。接受一期截肢的患者被排除在外。膝关节周围骨折合并腘动脉损伤的发生率为3%，而膝关节后脱位患者中16%有血管损伤（P<0.05）。38条受伤肢体中有14条（36%）需要截肢。这些患者入院时均无脉搏或多普勒信号，13例有严重软组织损伤。有脉搏或多普勒信号的患者无一例肢体缺失（P<0.05）。肢体缺失主要与受损组织的静脉流出受限和/或严重感染有关。动脉修复失败很少导致截肢，尤其是近年来。2例经血管造影证实有动脉损伤的患者接受了非手术治疗，无并发症发生。膝关节周围骨折相关血管损伤的发生率较低，但膝关节后脱位时略高。血管造影阳性率总体为9%，提示可能需要采取选择性方法。截肢率仍然很高，但通过综合多学科团队方法有所改善。对于无脉搏或多普勒信号且伴有严重软组织损伤的患者，一期截肢可能是合适的。
