| 四肢主干动脉损伤缺血时间的综合分析 |
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Received:February 27, 2015
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| 作者 | Author | 单位 | Unit | E-Mail |
| 祁峰 |
QI Feng |
宁波市医疗中心李惠利医院, 浙江 宁波 315040 |
Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China |
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| 李杰 |
LI Jie |
宁波市医疗中心李惠利医院, 浙江 宁波 315040 |
Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China |
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| 祁晓 |
QI Xiao |
宁波明州医院, 浙江 宁波 315100 |
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| 肖鲁伟 |
XIAO Lu-wei |
浙江中医药大学, 浙江 杭州 310053 |
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xlw@zjcm.net |
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| 期刊信息：《中国骨伤》2015年28卷，第10期，第932-935页 |
| DOI：10.3969/j.issn.1003-0034.2015.10.012 |
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目的:研究四肢主干动脉损伤缺血时间对肢体存活率的影响,分析缺血时间形成原因。
方法:对1996年6月至2012年11月收治的83例四肢主干动脉损伤患者进行回顾性研究,男77例,女6例;年龄16～52岁患者81例,中位年龄35岁,儿童2例分别为4岁和5岁。采用端端吻合75例,大隐静脉移植7例,人造血管桥接1例。统计保肢成功与失败患者入院前后缺血时间和总缺血时间,分析形成原因。统计不同缺血时间的肢体存活率,锐性切割伤和钝性伤的缺血时间和截肢率。
结果:肢体成活72例,截肢11例。保肢成功患者平均缺血时间(7.45±5.94) h,截肢患者平均缺血时间(13.73±14.00) h,两组缺血时间差异无统计学意义。缺血时间21～44 h组的截肢率高于缺血时间≤5 h、6～10 h和11～20 h的3个组(P=0.023,P=0.038,P=0.044).截肢原因可分为术中吻合失败,术后2～4 d的血管栓塞和晚期感染。
结论:肢体可以耐受比较长的缺血时间而保肢成功。只有超长缺血时间(>20 h),截肢率才有明显增加。长时间缺血的主要原因为院内的延误诊断,能否保肢主要取决于创伤的严重程度和血管修复技术,其次才是缺血时间过长。 |
| [关键词]:四肢 动脉 创伤和损伤 吻合术 缺血时间 |
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| Comprehensive analysis of the ischemic times of main artery injury in the limbs |
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Abstract:
Objective:To study the ischemic times of the main artery injury in the limbs and the influence on the limbs survival rate,and to analyze the reasons for the formation of the ischemia time.
Methods:From June 1996 to November 2012,83 patients with completely severed limb main artery treated in our hospital were retrospectively studied. There were 77 males and 6 females,including 81 adults(ranging in age from 16 to 52 years old,with a median age of 35 years old) and 2 children(4 and 5 years old respectively). Seventy-five patients were treated with end to end anastomosis,7 patients were treated with great saphenous vein transplantation,and 1 patient was treated with artificial blood vessel transplantation. The prior to admission ischemia time,after admission ischemia time and total ischemia time for successful and unsuccessful patients,as well as the causes of the formation of the ischemia time were studied. Limb survival rate of different ischemic time was counted. Sharpness injury or blunt injury ischemia time and amputation rate were researched statistically. All data were analyzed using SPSS statistical software.
Results:There were 72 limbs survived,11 amputated. The average ischemia time was (7.45±5.94) h for limb-salvage group and (13.73±14.00) h for amputation group. Prior to admission ischemia time between amputation and limb-salvage group had no significant difference. After admission the ischemia time in amputation group was longer than limb-salvage group. The amputation rate for ischemia time 21 to 44 h group was higher than other three groups(≤5 h,6 to 10 h,11 to 20 h)(P=0.023,0.038,0.044). Amputation reasons can be divided into anastomosis failure in the operation,vascular thrombosis 2 to 4 days after operation and late infection.
Conclusion:Vascular injury limbs can tolerate longer ischemia time and the limb salvage succeed. Only too long ischemia time(> 20 h),limb amputation rate increases significantly. The main cause of long time ischemia is delayed diagnosis in the hospital. Whether limb-salvage success mainly depends on the degree of trauma and the quality of the anastomosis than ischemia time. |
| KEYWORDS:Limbs Artery Wounds and injuries Anastomosis Ischemia time |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 祁峰,李杰,祁晓,肖鲁伟.四肢主干动脉损伤缺血时间的综合分析[J].中国骨伤,2015,28(10):932~935 |
| 英文格式: | QI Feng,LI Jie,QI Xiao,XIAO Lu-wei.Comprehensive analysis of the ischemic times of main artery injury in the limbs[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(10):932~935 |
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