【摘要】 目的探讨开放性胫骨平台骨折伴腘动脉损伤的治疗。方法回顾性分析2013年6月—2020年8月新疆医科大学第一附属医院骨科收治的开放性胫骨平台骨折伴腘动脉损伤19例。男性17例,女性2例;年龄18～74岁,平均40.3岁;右侧11例,左侧8例;致伤原因:道路交通伤10例,重物砸伤3例,高处坠落伤6例。受伤6h内行腘动脉和小隐静脉移植吻合术9例,直接端端吻合术8例,单纯修补术2例。Ⅰ期均行外固定架固定,待2～4周后侧支循环已完全建立、软组织损伤情况明显好转后,行Ⅱ期内固定手术处理。观察骨折愈合时间、术后并发症,末次随访采用Rasmussen膝关节功能评分标准、Lachman试验及膝关节活动度评定膝关节功能。结果患者均获得12～18个月门诊随访,平均13.6个月。其中18例患者血运稳定,1例患者在I期外固定架联合腘动脉和小隐静脉移植吻合术后小腿肌肉坏死,清创并截肢后行负压封闭引流(VSD),Ⅱ期植皮后创面愈合。18例患者Ⅱ期术后完全负重时间11～25周,平均14.2周。X线片骨折愈合时间11～23周,平均13.5周。18例患者中2例小腿麻木,口服营养神经药物(弥可保片)后症状好转; Rasmussen功能评分优15例,良2例,可1例,优良率为94.4%;膝关节活动度110～150°,平均128.6°。Lachman试验均为阴性。结论对于开放性胫骨平台后外侧骨折合并腘动脉损伤,伤后6h内修复腘动脉并予以外固定架固定,可以维持患肢长度和力线,尽早恢复血供,便于行Ⅱ期内固定手术,值得临床推广。更多还原

【Abstract】 Objective To investigate the treatment of open tibial plateau fracture with popliteal artery injury.Methods Nineteen cases of open tibial plateau fracture with popliteal artery injury treated in the Department of Orthopedics of The First Affiliated Hospital of Xinjiang Medical University from Jun. 2013 to Aug. 2020 were analyzed retrospectively. There were 17 males and 2 females; the age ranged from 18 to 74 years,with an average of 40.3 years; there were 11 cases on the right and 8 cases on the left; causes of injury: 10 cases of road traffic injury,3 cases of heavy object injury,and 6 cases of falling injury. Within 6 hours of injury,9 cases underwent popliteal artery and small saphenous vein transplantation and anastomosis,8 cases underwent direct end-to-end anastomosis and 2 cases underwent simple repair. All patients were fixed with external fixator in stage I. After 2-4 weeks,the collateral circulation had been completely established,the soft tissue injury was significantly improved,and stage II internal fixation was performed. The fracture healing time and postoperative complications were observed. At the last followup,the knee function was evaluated by Rasmussen knee function score standard,Lachman test and knee range of motion.Results All patients were followed up for 12-18 months,with an average of 13.6 months. Among them,18 patients had stable blood supply. One patient had leg muscle necrosis after stage I external fixator combined with popliteal artery and small saphenous vein transplantation and anastomosis,undergoing vacuum sealing drainage( VSD)after debridement and amputation,receiving wound healing after stage II skin grafting. The complete weight-bearing time of 18 patients after stage II operation was 11-25 weeks,with an average of 14.2 weeks. The bone healing time of X-ray film was 11-23 weeks,with an average of 13.5 weeks. Among the 18 patients,2 had leg numbness,and their symptoms improved after oral neurotrophic drugs( Mecobalamin tablets); Rasmussen functional score was excellent in 15 cases,good in 2 cases and fair in 1 case,with an excellent and good rate of 94.4%; the range of motion of knee joint was 110-150 °,with an average of 128.6 °． Lachman test was negative. Conclusion For open posterolateral tibial plateau fracture complicated with popliteal artery injury,early repair of popliteal artery and external fixation within 6 hours can maintain the length and force line of the affected limb,restore the blood supply as soon as possible,and facilitate phase II internal fixation,which is worthy of clinical promotion.更多还原