Orthopedic trauma of limbs associated with vascular injuries

<正>Objective:To evaluate the treatment for patients with major vascular injuries associated with traumatic orthopedic injuries. Methods:A total of 196 patients,aged from 4-67 years with the mean age of 29.88 years,had major vascular injuries associated with traumatic orthopedic injuries and were treated in our hospital in a period of 44 years.The most common mechanism of trauma was blunt trauma (67.3%),open injuries accounted for 32.4% and 54.5% of the injuries were located in the lower extremities.The vascular injury frequently happened in the femoral artery (26.7%)and popliteal artery(20.3%).The treatment principle consisted of aggressive resuscitation,Doppler imaging and stable bone internal fixation with subsequent vascular repair and debridement.The vascular repair for injuries included end-to-end anastomosis(80 cases, 39.6%),interpositional vein graft(94,46.5%),vascular decompression through fracture distraction(18,8.9%), arterial ligation(6,3.0%),vein patch(2,1.0%), bypass graft(2,1.0%),venous repair including autogenous vein graft(9,24.3%)and ligation(28, 75.7%)and prophylactical fasciotomy(15,7.4%). Postoperative amputation was performed in 16 cases (16.3%). Results:No intraoperative death was observed and all fractures united within 6 months.Limbs were salvaged in 180 patients(91.8%).Among these patients,early complications were found in 19 patients(9.7%) and late complications were observed in 8 patients(4.1%). Conclusions:A well-organized approach,based on a specific treatment principle,not only improves clinical outcome but also does good to excellent functional recovery for patients with severe orthopedic injuries and concomitant vascular lesion.