Combined skeletal and vascular injuries of the lower extremities.
Combined skeletal and vascular injuries of the lower extremities.
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下肢骨骼和血管联合损伤。
DOI：
10.1097/00005373-198207000-00028
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发表时间：
1982
期刊：
影响因子：
--
通讯作者：
R. Adkins
中科院分区：
文献类型：
--
作者：
F. Weaver;R. E. Rosenthal;G. Waterhouse;R. Adkins
为了确定对患有严重骨骼和动脉损伤的患者进行手术治疗的长期结果，作者回顾了 1970 年至 1981 年间在其机构接受这种损伤治疗的患者的记录。这些病例仅限于与血管损伤相关的股骨、膝关节和胫骨骨折和/或脱位。 31 名患者的 32 条肢体受伤符合我们的审查标准。骨科损伤分布如下：股骨骨折16例；胫骨骨折，20；和膝盖脱臼，四。百分之五十的伤者有神经功能缺损； 22 个肢体出现明显的软组织损伤；除 4 人外，其余所有人都尝试过动脉血运重建。血管手术包括大隐静脉旁路术、大隐静脉介入术、端端吻合术和外侧动脉缝合术。骨科修复一般采用外部手段完成，仅5例采用立即内固定治疗。长期结果分为优秀、一般或较差。截肢分为原发性截肢和继发性截肢。只有五个重建的肢体取得了优异的结果。百分之三十五的四肢被归类为具有公平结果。两个肢体的结果很差。四个肢体被初次截肢，七个肢体被二次截肢。研究发现相关的神经缺陷和/或严重的软组织损伤是决定重建工作最终成功或失败的主要因素。
In order to determine the long-term results of surgical treatment in patients with significant combined skeletal and arterial injuries, the authors reviewed the records of those patients treated for this injury between 1970 and 1981, at their institutions. These cases were confined to fractures and/or dislocations of the femur, knee, and tibia which were associated with vascular injuries. Thirty-one patients with 32 injured extremities fit these criteria for our review. The distribution of the orthopedic injuries were as follows: femoral fractures, 16; tibial fractures, 20; and knee dislocations, four. Fifty percent of the injuries had neurologic deficit; significant soft tissue injury was present in 22 extremities; and all but 4 had attempted arterial revascularization. Vascular procedures included saphenous vein by-pass, saphenous vein interposition, end-to-end anastomosis and lateral arteriorrhaphy. Orthopedic repairs were generally accomplished by external means with only five cases treated by immediate internal fixation. Long-term results were categorized as excellent, fair, or poor. Amputations were classified as primary and secondary. Excellent results were found in only five of the reconstructed extremities. Thirty-five percent of the extremities were classified as having a fair result. Two extremities had a poor result. Four extremities were primarily amputated, and secondary amputation was performed on seven extremities. Associated nerve deficits and/or significant soft tissue injuries were found to be the major factors determining the eventual success or failure of reconstructive efforts.