Davidović L, Lotina S, Kostić D, Velimirović D, Dukić P, Cinara I, Vranes M, Marković M
The Institute for Cardiovascular Diseases, Medical Centre of Serbia, Belgrade, Yugoslavia.
Cardiovasc Surg. 1997 Feb;5(1):37-41. doi: 10.1016/s0967-2109(96)00067-1.
The early postoperative results of 44 surgically treated popliteal arterial injuries from the Yugoslav civil war are reported. Of these patients, 41 (93%) were males and three (7%) were females, average age was 28 (range 6-45) years. Twenty patients (45%) had gunshot wounds and 24 (55%) explosive wounds. Twelve (28%) suffered isolated vascular damage, while 32 (72%) suffered concomitant bone fractures. Isolated arterial lesions were found in 24 (55%) cases, and concomitant arterial and venous lesions in 20 (45%). Twenty-four (55%) had primary reconstructions after haemostasis in the initial war hospital, and 20 (45%) secondary reconstructions after inadequate primary reconstruction in a regional war hospital. Artery procedures included 19 reverse saphenous vein graft interpositions, 10 reverse saphenous vein bypasses, 12 'in situ' saphenous vein bypasses and five lateral subcutaneous saphenous vein bypasses. The early graft patency rate was 100%, and limb salvage 72%. Major amputation was performed in 28%. Concomitant bone fractures, secondary reconstructions, secondary haemorrhage from an infected graft, and explosion wounds significantly increased the amputation rate (P < 0.01). Eleven amputations were performed after an anatomic, and only one after an extra-anatomic reconstruction (P < 0.01). The authors recommend an in situ or lateral subcutaneous reconstruction in cases of complicated popliteal artery injuries, such as concomitant bone fractures accompanied by massive soft tissue damage, and this type of reconstruction should also be used if infection is present or the procedure is delayed.
本文报告了南斯拉夫内战期间44例接受手术治疗的腘动脉损伤患者的早期术后结果。这些患者中，41例（93%）为男性，3例（7%）为女性，平均年龄28岁（范围6 - 45岁）。20例（45%）有枪伤，24例（55%）有爆炸伤。12例（28%）仅遭受血管损伤，32例（72%）伴有骨折。24例（55%）发现孤立性动脉损伤，20例（45%）伴有动静脉联合损伤。24例（55%）在初始战地医院止血后进行了一期重建，20例（45%）在地区战地医院一期重建不充分后进行了二期重建。动脉手术包括19例大隐静脉倒置移植搭桥、10例大隐静脉逆向旁路移植、12例大隐静脉原位旁路移植和5例大隐静脉皮下外侧旁路移植。早期移植血管通畅率为100%，保肢率为72%。28%的患者进行了大截肢。伴有骨折、二期重建、感染移植血管继发性出血和爆炸伤显著增加了截肢率（P < 0.01）。11例截肢在解剖重建后进行，仅1例在解剖外重建后进行（P < 0.01）。作者建议，对于复杂的腘动脉损伤，如伴有大量软组织损伤的骨折，应采用原位或皮下外侧重建，如果存在感染或手术延迟，也应采用这种重建方式。
