摘要
目的探讨外伤导致的下肢动脉损伤的诊疗方法及临床效果。方法回顾性分析2013年1月至2021年6月宜昌市中心人民医院血管外科收治的77例外伤性下肢动脉损伤患者的临床资料。男性65例,女性12例,平均年龄47.4岁(范围:7~75岁)。77例患者中,开放性损伤56例(72.7%),闭合性损伤21例(27.3%);损伤累及髂动脉9例(11.7%),股总动脉7例(9.1%),股浅动脉1例(1.3%),腘动脉11例(14.3%),膝下动脉49例(63.6%)。分析患者的治疗方式和临床效果。结果77例患者中,1例累及髂内动脉的骨盆骨折患者和1例累及股总动脉的多发伤患者,因损伤严重,于术前因循环衰竭死亡;75例患者接受血管相关手术,其中67例行开放手术,包括动脉结扎术24例、动脉重建术40例、覆膜支架植入术1例、一期截肢术2例;8例行动脉栓塞术。总体病死率为6.5%(5/77),均为闭合性损伤,除2例术前死亡患者外,3例累及髂内动脉的骨盆骨折患者虽接受髂内动脉栓塞术,但因复合损伤严重,术后因多器官功能衰竭死亡。截肢患者8例(10.4%,8/77),5例为闭合性损伤,3例为开放性损伤,除2例损伤严重患者行一期截肢外,6例血管重建患者因缺血再灌注损伤行二期截肢(4例为腘动脉损伤,2例为膝下三分支动脉损伤)。患者术后随访17个月(范围:2个月至8年)。1例股动脉损伤行自体大隐静脉旁路移植患者,术后半年复查下肢动脉CT血管造影发现远端吻合口狭窄30%,2例腘动脉血管修补患者随访1年出现踝肱指数<0.8,但患者均无间歇性跛行症状,未行再次干预。5例患者因下肢损伤严重,骨折及皮肤损伤延迟愈合,其中2例为截肢残端创面愈合欠佳,经多次清创后于术后3~5个月愈合,另外3例为血管损伤合并胫骨骨折,术后胫骨愈合延迟,但未出现血管缺血症状。其余患者均恢复良好,无其他严重并发症发生。结论外伤导致的下肢动脉损伤患者死亡和致残比例较高,根据损伤�
Objective To analyze the treatment and clinical prognosis of lower extremity arterial injury caused by trauma.Methods The clinical data of 77 patients with traumatic lower extremity arterial injury admitted to Department of Vascular Surgery,Yichang Central People′s Hospital from January 2013 to June 2021 were collected retrospectively.There were 65 males and 12 females,with an average age of 47.4 years(range:7 to 75 years).Among the 77 patients,56 cases(72.7%)had open injury and 21 cases(27.3%)had closed injury.Iliac artery was injured in 9 cases(11.7%),common femoral artery in 7 cases(9.1%),superficial femoral artery in 1 case(1.3%),popliteal artery in 11 cases(14.3%)and inferior knee artery in 49 cases(63.6%).The treatment methods and clinical effects were analyzed.Results One case with pelvic fracture combined the internal iliac artery injury and 1 case with multiple injuries involving the common femoral artery died of circulatory failure before surgery.Seventy-five cases received vascular-related operations,including arterial ligation in 24 cases,arterial reconstruction in 40 cases,stent graft implantation in 1 case,primary amputation in 2 cases,and arterial embolization in 8 cases.The overall mortality rate was 6.5%(5/77),all of which were closed injuries.Except for 2 cases who died before surgery,3 cases with pelvic fracture combined the internal iliac artery injury died of multiple organ failure after internal iliac artery embolization.There were 8 cases received amputation(10.4%,8/77),5 cases with closed injury and 3 cases with open injury.In addition to 2 cases with primary amputation,6 cases underwent secondary amputation due to ischemia-reperfusion injury after revascularization(4 cases with popliteal artery injury and 2 cases with subpatellar artery injury).The average followed-up time was 17 months(range:2 months to 8 years).One patient with femoral artery injury underwent autologous great saphenous vein bypass,and lower limb artery CT angiography was re-examined 6 months after the operation,and 30
作者
梅菲
王科委
孙建锋
黄明魁
范家伟
李裕
官文飞
Mei Fei;Wang Kewei;Sun Jianfeng;Huang Mingkui;Fan Jiawei;Li Yu;Guan Wenfei(Department of Vascular Surgery,Yichang Central People′s Hospital,the First Clinical Medical College of China Three Gorges University,Yichang 443003,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2022年第1期63-68,共6页
Chinese Journal of Surgery
关键词
外伤
下肢动脉损伤
截肢率
死亡率
Trauma
Lower limb arterial injury
Amputation rate
Mortality
