外伤性后足部分截肢伴胫骨后动脉损伤

Q3 Medicine
P. V. Iskusov, S. V. Bragina, A. E. Sovershaev, E. I. Sobolev, A. S. Zvorykin, E. P. Sharypova
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引用次数: 0

摘要

距骨和跟骨骨折约占骨骼损伤的2%,占足部骨折的70%。后足开放性骨折的诊断率为30%。根据R.B. Gustilo, J.T. Anderson(1976)的分类,一半以上的损伤为III型。在6.4%的患者中观察到胫骨后动脉损伤。3- 60%的截肢是由于骨性血管损伤、坏疽和软组织挤压造成的。目的是展示一个罕见的临床病例外伤性部分后足截肢在右侧与开放的跟骨和距骨骨折和胫骨后动脉损伤,并导致良好的结果。材料与方法本文报告一名36岁的外伤性后足部分截肢及胫骨后动脉损伤患者的临床病例。结果患者右足解剖及功能恢复正常。骨和血管损伤没有临床指南和统一的分类,对于包括开放性骨折和血管损伤在内的复合损伤的治疗也没有通用的方法。治疗方式的选择、骨血管性损伤的诊断取决于影响损伤的外部和内部因素。右脚后脚损伤患者的血管创伤治疗方法包括早期骨血管性损伤的初级手术治疗,使用跟骨保留技术精确复位和稳定固定,胫骨后动脉修复,改善血液流变学,降低凝血性,解决组织缺血和提供足够的区域麻醉的综合药物治疗。结论采用器官保留策略的血管创伤入路和骨科、创伤外科医生、血管外科医生、麻醉师-复苏员组成的多学科团队的综合因素和使用有助于足部抢救,改善功能和可保障性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Traumatic partial hindfoot amputation with injury to the posterior tibial artery
Introduction Talus and calcaneus fractures account for about 2 % of skeletal injury and 70 % of the foot fractures. Open fractures of the hindfoot are diagnosed in 30 %. More than half of the injuries are graded as type III according to classification of R.B. Gustilo, J.T. Anderson (1976). Injury to the posterior tibial artery is observed in 6.4 % of patients. Amputations resulting from an osseous-vascular injury and gangrene and crushed soft tissues are observed in 3-60 %.The objective was to demonstrate a rare clinical case of traumatic partial hindfoot amputation on the right side associated with open calcaneus and talus fracture and injury to the posterior tibial artery and resulted in a good outcome.Material and methods A clinical case of a 36-year-old patient who suffered a traumatic partial hindfoot amputation and injury to the posterior tibial artery.Results Restoration of the anatomy and the function of the right foot was achieved in the patient.Discussion There are no clinical guidelines and a unified classification for bone and vascular injuries and no universal method for the treatment of a combined injury including an open fracture of bones and injury to blood vessels. The choice of treatment modality, diagnosis of osteovascular injuries are produced on an individual basis depending on the external and internal factors affecting the injuries. An angiotraumatological approach used to treat the patient with the hind foot injury on the right included early primary surgical treatment of the osteovascular injury, accurate reduction and stable fixation using a sparing technique for the calcaneus, repair of the posterior tibial artery, complex drug therapy to improve blood rheology, reduce coagulability, address tissue ischemia and provide adequate regional anesthesia.Conclusion The combination of factors and use of an angiotraumatological approach employing organ sparing strategy and a multidisciplinary team of orthopaedic and trauma surgeons, angiosurgeons, anesthesiologists-resuscitators facilitated foot salvage, improved function and supportability.
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来源期刊
Genij Ortopedii
Genij Ortopedii Medicine-Surgery
CiteScore
0.70
自引率
0.00%
发文量
104
审稿时长
12 weeks
期刊介绍: Journal’s main goal is to contribute to the development of the contemporary medical science via presentation of fundamental and applied original scientific studies to the scientific and practical medical community that would widen and deepen the understanding of the most important problems in the field of traumatology, orthopaedics, and related specialties. Our journal provides a direct open access to its content which is based on the principle that the open access option promotes global exchange of knowledge and experience. Journal’s strategy: -Development of the journal as a scientific platform for researchers, doctors, post-graduates and residents -Attraction of highly-cited authors to publish their studies -Selection of manuscripts of scientific interest for readers that will impact on journal citation index in RINC -Increase in the portion of publications submitted by foreign authors and studies conducted in association with foreign scientists; growth of citations in the journals that are included into global systems of indexing and reputable databases -Improvement of the Journal’s web site in two languages for a greater accessibility by authors and readers -Introduction of the Journal into global indexing systems
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