popliteal artery injury
Introduction
Introduction to radial artery injury Most of the knee dislocation, fracture, and blunt axillary injury caused by violence, the limb amputation rate is significantly increased after the injury, so we must strive to reconstruct the blood supply in the treatment. Clinically common femoral supracondylar fractures cause a radial artery injury due to contraction of the distal end of the fracture due to contraction of the posterior malleolus muscle. In addition, traumatic knee dislocation, comminuted ankle fractures and blunt trauma to the axillary fossa are another common clinical cause. basic knowledge The proportion of illness: 0.0001%, more common in violent sharp trauma Susceptible people: no specific population Mode of infection: non-infectious Complications: Fascia compartment syndrome
Cause
Cause of radial artery injury
Stab wound of the supracondylar fracture of the femur (30%):
The femoral condyle is the transition of dense bone and cancellous bone. It is caused by car accident and falling from high places. Older people may suffer from fractures due to osteoporosis and little violence.
Strong violence caused knee dislocation (30%):
A strong direct violent impact on the upper end of the humerus or indirect violence causes the knee joint to be rotated or stretched, causing the upper end of the humerus to dislocate backwards and forwards.
Ankle comminuted fracture (30%):
In addition to the intercondylar fractures of the femur, more often with fractures on the upper or adjacent sites, which are like T-shaped, called T-shaped fractures. The displacement of the fracture end is more obvious.
Sharp stab wound can cause injury (5%):
Fractures with vascular nerve injury, fractures of all types may occur.
Pathogenesis
The radial artery starts from the lower edge of the adductor muscle tube and continues with the femoral (shallow) artery. It descends to 5-8 cm below the tibial plateau and is divided into the anterior tibial artery and the radial artery. Because of the radial artery and the upper part of the femoral condyle The bone surface is close together, so the clinically common femoral supracondylar fracture, due to the contraction of the distal end of the fracture caused by the contraction of the posterior malleolus muscle, causing the radial artery injury has become a concern, in addition, the traumatic knee joint Dislocation, comminuted ankle fractures and blunt trauma to the axillary fossa are also common clinical causes, and should also be vigilant for iatrogenic factors, especially in the treatment of femoral condyle fractures. It is not uncommon.
Prevention
Radial artery injury prevention
Pay attention to the prevention and treatment of calf muscle interval syndrome. From a certain point of view, the calf muscle interval syndrome and the radial artery involvement can be mutually causal and easily constitute a vicious circle. Therefore, it must be eliminated to prevent an increase in the condition.
Nursing measures:
1. Closely observe the changes in the vital state of the patient. The pulse and blood pressure are measured every 15 minutes. It is found that the patient is pale, the pulse is accelerated, and the blood pressure is lowered. The rescue measures should be taken quickly, and the intravenous blood transfusion channel should be established quickly when the doctor is notified.
2. Closely observe the affected limb and take appropriate care.
(1) Observe the brakes and knees of the affected limb. If the patient's distal limb is found to have insufficient blood supply or the dorsal artery of the foot is not touched, the patient should immediately give the patient a lower occipital pillow, bend the knee 90°, bend the hip, and brake the affected limb to reduce the tension of the radial artery. Before the fracture is reset, the Brown frame or the plate frame is disabled to raise the affected limb or tow.
(2) Observing the local hematoma, the rubber tube tourniquet on the bedside, if the swelling around the affected limb continues to increase, the preparation for the rescue of bleeding should be done well.
(3) Observing the blood circulation of the affected limb and judging the degree of radial artery injury provide the basis for treatment. Perceptual abnormalities at the distal end of the affected limb, ischemic pain, pale chills, and dyskinesia are reliable evidences of radial artery injury. If the radial artery is only squeezed by the fracture end, the distal dorsal artery is pulsating 10 minutes after the affected limb bends the knee. There will be a significant improvement; while the distal end of the affected limb has blood supply, the skin temperature from the calf to the foot is reduced in a segmental manner, and the radial artery of the foot is not accessible. In addition to local swelling, the radial artery rupture is pale, the distal part of the limb is pale, the dorsal artery cannot be touched, and some may have physical symptoms.
3, the tibial plateau fracture once combined with radial artery injury, surgical exploration and revascularization is a reliable means of treatment of this disease. The pre- and post-operative care is based on microsurgical care routines.
Complication
Radial artery injury complications Complications fascial compartment syndrome
Pay attention to the occurrence of calf muscle compartment syndrome, and if it is diagnosed in time, timely treatment.
Symptom
Symptoms of radial artery injury Common symptoms Ischemic foot and posterior tibial artery below the calf... Acute pain, hematoma formation, dorsal artery pulsation, peripheral neuritis, calf swelling, pain
Similar to the clinical symptoms of femoral artery involvement, the ischemic and dorsiflexion of the dorsal artery is weakened (or disappeared); if it is caused by supracondylar fracture, it has specific signs of the fracture, including flexion of the lower thigh. Malformation, elastic fixation, severe pain and limited mobility. When the blood supply of the calf is insufficient, hemorrhagic peripheral neuritis may occur and there are symptoms such as pain, allergies and numbness.
Examine
Brachial artery injury examination
1, B-ultrasound
Can generally understand the arterial injury, the presence or absence of secondary thrombosis, pseudoaneurysm and iliac vein injury;
2, X-ray inspection
Can be confirmed whether there is a fracture;
3, CTA or arteriography
Identify the site of the radial artery injury and guide the surgical treatment.
Diagnosis
Diagnosis and diagnosis of radial artery injury
According to the history of trauma, the type and characteristics of fractures, and clinical manifestations, it is generally not difficult to make a diagnosis.
The faster the diagnosis, the better, because the diagnosis is very close to its prognosis, it is not difficult to diagnose the brachial artery injury. It is difficult to diagnose, especially when there is progressive hematoma in the armpit, which gradually increases and synchronizes with the pulse beat. This indicates that the radial artery is damaged; of course, it is easier to confirm the diagnosis of blood in the wound on the artery. In addition, it can also be judged from the disappearance (or weakening) of the dorsal artery pulsation and the extent and direction of displacement of the femoral condyle or ankle fracture. It is difficult to diagnose, or to determine pseudoaneurysm and arteriovenous fistula. An angiography can also be performed. It is easier to operate directly from the iliac crest through the femoral artery puncture.
