摘要
目的探讨胫腓骨骨折合并动脉损伤的临床特点和诊治方法。方法回顾性调查在605例2001年10月至2005年6月在本院就诊的胫腓骨骨折患者中，伴有胭动脉、胫前和（或）胫后动脉损伤的2l例患者资料。结果胭动脉损伤14例（66．7％），其中4例伴胭静脉损伤；胫前动脉4例（19．0％），其中2例伴胫前静脉损伤；胫前胫后动脉3例（14．3％），其中伴胫前、胫后静脉损伤各1例。血管吻合术11例，取栓加血管修补术5例，自体大隐静脉移植1例，人工血管移植3例，单纯胫前动脉残端结扎止血1例。最终8例（38．1％）患者保肢成功，13例行二期截肢（趾）手术。截肢（趾）组13例患者均于骨折固定术后48h内发现患肢足背动脉搏动减弱或消失，皮肤色泽改变，与保肢组相比差异具有统计学意义（P〈0．01）。5例患者行骨折固定前发现伴有骨筋膜室综合征于术中减压，另有2例术后预防性切开减压，其中3例最终保留患肢。结论对于胫腓骨骨折，特别是胫骨平台骨折患者，需警惕伴行动脉损伤。早期发现、早期诊断合并重要动脉损伤的胫腓骨骨折，及时重建血管并处理骨筋膜室综合征，对患肢预后有重要意义。
Objective To study the clinical characteristics of tibiofibula fracture with arterial injury. Method A retrospective analysis was carried out in the 21 patients with tibiofibula fracture with arterial injury （including popliteal artery, anterior and posterior tibial arteries）. Results There were 14 （66.7 % ） patients with popliteal arterial injury, four （ 19.0 % ） patients with anterior tibial arterial injury, and 3 （ 14.3 % ） patients with both anterior and posterior tibial arterial injury. Anastomosis of blood vessel was performed in 11 patients, embolectomy plus angiorrhaphy in 5 patients, autologous transplantation of great saphenous vein in 1 patient, polytetralluoroethylene （PTFE） graft in 3 patients, and ligation of the anterior tibial artery in 1 patient. Eight patients had their limbs preserved （salvaged group ）, while 13 patients underwent two-stage amputation （amputated group）. The 13 patients in amputated group had high incidence of symptoms such as diminished or disappeared arterial pulse in the suffered limb, changed skin color, and compared with salvaged group, there was significantly different （P 〈 0.01 ）. Five patients had suffered from osteofascial compartment syndrome before fLxation and received fasciotomy, another 2 patients without compartment syndrome underwent preventive faseiotomy, and at last three of them had their limbs saved. Conclusions Arterial injury should be paid more attention when treating patients with tibial fracture, especially with fracture of tibial plateau. Early re-diagnosis, early establishing of the injured artery and early treatment of osteofascial compartment syndromes are important for a prognosis of the limbs.
出处
《中华急诊医学杂志》
CAS
CSCD
2007年第3期283-286,共4页
Chinese Journal of Emergency Medicine
关键词
胫腓骨骨折
动脉损伤
早期诊断
筋膜室综合征
Tibiofibula fracture
Arterial injury
Early diagnosis
Osteofascial compartment syndrome
