下肢主要血管伤的改良手术治疗.DOC

下肢主要血管伤应用可吸收医用膜手术治疗 唐学锋 庄文杰 陈实 （贵阳医学院第二附属医院骨科.贵州 凯里 556000） 关键词:下肢;血管损伤;可吸收医用膜 摘要 目的 探讨下肢血管伤应用可吸收医用膜手术治疗效果。方法临床收集下肢血管损伤病人34例均采用可吸收医用膜手术治疗，通过扩大损伤血管探查入路，修复下肢血管，采用可吸收生物膜包裹。结果 肢体成活28人，占82%，术后3—7天由于各种原因肢体坏死而截肢的2人，占6%。机理 可吸收医用膜的物理隔离作用将手术创面和周围组织分开，防止成纤维细胞对手术创面的入侵，在手术创面和周围组织之间形成一自然屏障，当膜按照设计的时间降解后，该屏障成为一个微小的间隙。结论 通过手术是治疗下肢血管损伤最有效的方法，而改良术式采取扩大损伤动静脉探查入路，术野暴露清晰，对损伤血管进行充分的松解和修复，修复的血管用可吸收生物膜包裹，减少炎性反应和吻合血管漏及组织粘连，取得良好临床效果。 Key words: lower limb; vascular injury; the absorbable membrane {Summary } Objective To discuss the effects of the treatment of vascular injuries in lower limb with the DIKFILM. Method Clinical collection of 34 cases were treated by the DIKFILM, through expanding exploration into the way of vascular injury, repair lower arteries, wrapped with absorbable membrane. Result The bodies of 28 persons were survived , accounted for 82%. Two persons had limb necrosis and amputation after 3-7 days for various reasons, accounted for 6%. Mechanism Absorbable membrane separated the surgical wound and surrounding tissue in order to prevent the fibroblasts from invasion. It became a natural barrier between the surgical wound and surrounding tissue. The barrier became a tiny space when the membrane degradated in accordance with the design time. Conclusion The operation is the most effective way for the vascular injury of lower limb. The improved operation has expanded exploration and clear surgical field. It has the full release and repair for the injuried vascular .The absorbable membrane can reduce the inflammatory response and the vascular leakage ,the adhesion of tissue. It can achive good clinical effect. 引言 下肢血管伤平时很常见，近年来有增加的趋势，及时诊断和手术治疗的重要性如何强调亦不过分，对临床症状表明四肢主要动脉伤可能性较大而又不能确诊的病例亦应早期手术探查[1]延误诊断和治疗是肢体血管伤高截肢率的主要原因[2]。血管伤也直接威胁患者的生命需急诊手术治疗[3]。本组资料为2005年—2010年我科34例下肢严重血管伤，采用可吸收医用膜，扩大损伤血管探查入路，修复下肢血管，可吸收生物膜包裹修复血管。骨折固定尽量从简，有效，争取时间进行血管修复。做预防性广泛筋膜间隙切开，临床效果良好。 资料和方法 一般资料 本组患者34例（男27例，女7例），平均年龄29.4岁（12岁--54岁），损伤原因最常见的是交通事故15例，其次是建筑坠落物及煤矿塌方损伤9例，锐器刺伤6例，股动脉损伤8例，腘动脉损伤16例，胫前或胫后动脉伤6例，股