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題 名 | Blunt Vascular Injury Associated with Traumatic Floating Knee=浮膝骨折伴隨之血管傷害 |
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作 者 | 唐慧君; 謝式洲; 李經維; | 書刊名 | 中華民國整形外科醫學會雜誌 |
卷 期 | 17:3 2008.09[民97.09] |
頁 次 | 頁271-281 |
分類號 | 416.26 |
關鍵詞 | Floating knee injury; Blunt vascular injury; |
語 文 | 英文(English) |
中文摘要 | 浮膝骨折的定義是發生在膝關節兩端的長骨骨折。由於膝關節本身解剖學上的特性浮膝骨折常常伴有膕動脈的傷害。所以臨床對對浮膝骨折的病人必須審慎地評估及監測血管的傷害,如果忽略了血管的傷害,其後果往往不堪設想。 本報告第一位病人是膕動脈延遲性缺血,受傷後並未有立即的動脈供血不足情形,但是在術後第四天卻開始發現肢端缺血,雖經注射肝素及血管重建手術仍遭受截肢命運;第二位是受傷之後即刻診斷出膕動脈阻塞,其MESS(Mangled Extremity Severity Score)分數最高,但因立即的膕動脈重建手術,病人下肢得以保留。第三位起初並未有動脈供應不足的情形,經過小心的評估及監測後,下肢亦得以保留。 浮膝骨折中延遲性的動脈供血不足並不多見,其可能原因為腔室症候群,血管內膜受損而產生偽動脈瘤或血栓。本篇報告提醒對於浮膝骨折的病人,醫師需提高警覺病患是否有神經血管的損傷。動脈攝影或電腦斷層血管攝影對於診斷此種傷害有極大的幫助。 |
英文摘要 | Purpose: Blunt vascular injury should be carefully evaluated and monitored after floating knee injury. Neglect of such injury may cause devastating results. We describe three cases of traumatic floating knee injuries with different outcomes. Patients and Methods: Of 3 traumatic floating knee injury patients, the first case suffered from delayed arterial insufficiency from total occlusion of popliteal artery; the second had popliteal artery occlusion which was noted immediately after trauma, and the third with adequate circulation throughout. The mangled Extremity Severity Score (MESS) and outcomes of these 3 cases were compared. Results: The first patient had sufficient circulation initially but thrombosis developed on the 4th post-operative day. Heparinization was given and followed with bypass grafting. Distal foot developed gangrene change in spite of above treatment. The second case, who was found to have acute popliteal artery occlusion, had interposition grafting immediately. The third one, without compromising circulation at the beginning, was monitored carefully after trauma. The results of latter two were limb-salvaged. Conclusion: Floating knee injury often associates with blunt arterial injury. Delayed arterial insufficiency may be resulted from compartment syndrome, partial intima tear developing pseudoaneurysm or thrombosis. Neurovascular injury should be bewared of particularly for theses patients with floating knee injury. Angiography or CT angiography is helpful for evaluating such devastating injury. Early detection and repair of vessel injury is the key point of limb salvage. (J Plast Surg Asso R.O.C. 2008; 17:271~281) |
本系統中英文摘要資訊取自各篇刊載內容。