Porcellini M, Bernardo B, Capasso R, Bauleo A, Baldassarre M
Cattedra di Chirurgia Vascolare, Università degli Studi di Napoli Federico II.
Minerva Cardioangiol. 1997 Apr;45(4):131-8.
Blunt arterial injuries secondary to bone fractures are frequently associated with nerve, vein and soft tissue lesions. A delayed diagnosis or treatment is the main cause of high amputation rate. Thirty-four patients presenting acute arterial occlusion (15 cases), false aneurysms (13 cases) or AVFs (6 cases) of the extremity were identified between 1983 and 1995. To repair injured arteries, ligation (3 cases), patch angioplasty (6 cases), autogenous vein (15 patients) or PTFE (4 cases) interposition or bypass grafting were made. Percutaneous embolization by coils was performed in 3 AVFs of small limb arteries. Associated venous lesions were treated in 9 patients. External fixation of long bone fractures was made in 29 patients, before vascular reconstruction, to prevent further injury during orthopedic stabilization. Fasciotomies were made in 6 patients to treat compartmental hypertension. Early reexplorations were necessary to correct technical defects in 4 patients. Hyperbaric oxygen therapy was applied in 7 patients to control bacterial contamination and improve wound healing. Primary (2 cases) or secondary (3 cases) amputations were carried out in unsalvageable limbs. Nerve or extensive muscle damage caused poor functional outcome in 4 patients. A multidisciplinary diagnostic and management strategy is required to improve limb and patient survival.
骨折继发的钝性动脉损伤常伴有神经、静脉和软组织损伤。诊断或治疗延迟是高截肢率的主要原因。1983年至1995年间，共确定了34例出现急性动脉闭塞（15例）、假性动脉瘤（13例）或动静脉瘘（6例）的肢体患者。为修复受损动脉，分别进行了结扎（3例）、补片血管成形术（6例）、自体静脉移植（15例）或聚四氟乙烯移植（4例）或旁路移植术。对3例四肢小动脉动静脉瘘进行了经皮弹簧圈栓塞。9例患者同时治疗了相关的静脉损伤。29例患者在血管重建前对长骨骨折进行了外固定，以防止在骨科固定过程中造成进一步损伤。6例患者进行了筋膜切开术以治疗骨筋膜室高压。4例患者需要早期再次手术以纠正技术缺陷。7例患者接受了高压氧治疗以控制细菌污染并促进伤口愈合。对无法挽救的肢体进行了一期截肢（2例）或二期截肢（3例）。4例患者因神经或广泛肌肉损伤导致功能预后不良。需要多学科的诊断和管理策略来提高肢体保存率和患者生存率。
