【摘要】 目的研究腘动脉损伤及早诊断与合理治疗方法的选择。方法选取25例诊治和随访资料完整的腘动脉损伤患者,其中锐性损伤6例(24%),钝性损伤19例(76%);合并开放性骨折10例(40%),闭合性骨折及膝关节脱位13例(52%),静脉损伤3例(12%),神经损伤5例(20%);分析延迟诊断原因,比较腘动脉损伤原因、类型、合并损伤及发病到救治时间与预后的关系。结果手术修复腘动脉同时取栓20例(80%),血管腔内治疗5例(20%);血供完全恢复16例(64%),改善3例(12%),截肢6例(24%)。发病6~8 h内救治者截肢率明显低于8 h以上者(P<0.05);钝性损伤或与合并损伤同时存在者截肢率明显高于锐性损伤者(P<0.05)。结论受伤至治疗的时间>8 h、合并膝关节脱位及周围损伤是致残的主要原因。及早诊断、以手术修复同时取栓为主要治疗手段,血管腔内治疗是有效的补充治疗手段。更多还原

【Abstract】 Objective To investigate the early diagnosis and rational treatment of popliteal artery injury so as to improve the lower limb salvage rate. Methods The clinical and follow-up data integrity of 25 patients with popliteal artery injury was systematically studied. In these patients,19( 76%) cases were blunt injury and 6( 24%) cases were penetrating injury. The combined injury included open fracture in 10 cases( 40%),the knee joint dislocation with closed fracture of lower limb in 13( 52%),nerve injury in 5( 20%) and venous injury in 3( 12%),respectively. The cause of delayed diagnosis and relationship between prognosis and type of injury,complications,the duration from injured to treatment time were analyzed. Results 20 cases were operated to repair the popliteal artery.Endovascular treatment in 5 cases,the blood supply completely recovered( 64%) in 16 cases,improved in 3 cases( 12%),6 cases( 24%) amputed,respectively. Rate of amputation within 6 ~ 8 hours was significantly lower than that of the more than 8 hours from the injuried to treatment time( P < 0. 05). Amputation rate in blunt injury and combined injury was significantly higher than that of sharp injury( P < 0. 05). Conclusion The duration from injury to surgery more than 8 h,combined with knee joint dislocation and wound around knee is a major cause of morbidity. Operation with arterial thrombectomy is the main treatment,while endovascular treatment is a complementary treatment to save the lower limb.更多还原