摘要
目的通过系统综述探讨股骨转子间骨折并发假性动脉瘤的发病年龄、发病原因、发病部位、发病时间、治疗方法及预后。方法在国内外多个数据库检索股骨转子间骨折并发假性动脉瘤文献,共检索出76篇,经文题、摘要、全文内容二次筛选,共筛选出45篇文献;收集每例入选患者的发病年龄、性别、发病原因、发病部位、发病时间、治疗方法及预后等,采用系统分析的方法对数据进行分项研究。结果筛选出的45篇文献中共54例与股骨转子间骨折相关的假性动脉瘤报道,男25例,女27例,2例未明确性别;年龄43~94岁,其中<60岁4例,61~70岁6例,71~80岁17例,81~90岁25例;45例发生于股深动脉,3例发生于股浅动脉,臀上动脉、旋股内侧动脉、旋股外侧动脉、股动脉各1例,未说明位置2例;假性动脉瘤发生时间:骨折后1周内17例,1~3周8例,3周至3个月19例,3个月以上2例,未提供发生时间者8例。54例患者中,明确发生原因的有41例,包括骨折块损伤血管21例;医源性损伤20例,其中螺钉或钻头直接损伤血管的发生率最高,为55%(11/20)。53例明确治疗假性动脉瘤方法,其中22例行血管栓塞治疗,10例行手术缝合,8例行手术结扎,4例手术切除,5例使用覆膜支架,4例使用凝血酶注射治疗。54例患者中,42例获得随访,假性动脉瘤均未复发,亦未发生与假性动脉瘤相关的并发症。结论股骨转子间骨折并发假性动脉瘤高发病年龄为71~90岁,骨折后1周内及骨折后3周到3个月发病者多,常因骨折碎块损伤血管及医源性损伤血管所致,发生的部位多见于股深动脉。治疗方案包括血管栓塞治疗、手术结扎、缝合或切除假性动脉瘤、覆膜支架及凝血酶注射,预后一般较好。
Objective To summarize the age,gender difference,cause,location,time,treatment and prognosis of femoral intertrochanteric fracture complicated with pseudoaneurysm.and analyze the influence of different treatment methods on the occurrence of femoral intertrochanteric fracture complicated with pseudoaneurysm.Methods Using the method of systematic literature review,a total of 76 literatures were retrieved from multiple(latal)ases at home and abroad,and 45 literatures were screened out through the second screening of title,abstract and full text.The patients with intertrochanteric fracture complicated with pseudoaneurysm were selected as the research objects,and the duplicate cases were deleted;the age,gender,onset age,etiology,location,treatment and prognosis of the disease were retrospectively analyzed.Results A total of 54 cases of femoral intertrochanteric fracture related pseudoaneurysms were selected from 45 literatures,including 25 males and 27 females,and 2 cases had no gender;aged from 43 to 94 years old,and 4 cases were younger than 60 years old,6 between 61 and 70,17 between 71 and 80,and 25 between 81 and 90.Forty-five cases occurred in deep femoral artery,3 cases in superficial femoral artery,1 case in superior gluteal artery,1 case of medial circumflex artery,1 case of lateral circumflex femoral artery,1 case of femoral artery,and 2 cases of unknown location.The occurrence time of pseudoaneurysm:17 cases within 1 week after fracture,8 cases from 1 week to 3 weeks,19 cases from 3 weeks to 3 months,2 cases more than 3 months,and 8 cases unknown.The causes of pseudoaneurysm:among the 54 patients,41 cases had definite causes,including 21 cases of vascular injury caused by fracture block;20 cases of iatrogenic injury,of which the incidence of direct injury of blood vessels by screw or drill was the highest,accounting for 55%(11/20).Twenty-two cases were treated with vascular embolization,10 cases with surgical sutures,8 cases with surgical ligation,4 cases with resection of pseudoaneurysm,5 cases with covered stent,and 4 cases with thrombin injection.There were 42 cases who had follow-up data,and no recurrence and other complications were found during the follow-up period.Conclusion The peak age of femoral intertrochanteric fracture complicated with pseudoaneurysm was 71-90 years old.The incidence of femoral intertrochanteric fracture complicated with pseudoaneurysm was more often within 1 week after fracture and 3 weeks to 3 months after fracture,due to fracture fragments and iatrogenic vascular injury caused by the location of the profundus femoris artery.Treatment options include vascular embolization,surgical ligation,suture or resection of pseudoaneurysm,covered stent and thrombin injection,and the prognosis is generally good.
作者
张立峰
冯卫
佟雁翔
王彦
于成涌
张哲汉
薛飞
王文选
贾燕飞
Zhang Lifeng;Feng Wei;Tong Yanxiang;Wang Yan;Yu Chengyong;Zhang Zhehan;Xue Fei;Wang Wenxuan;Jia Yanfei(Department of Orthopaedics,the Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010030,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2021年第8期506-514,共9页
Chinese Journal of Orthopaedics
基金
内蒙古自然科学基金(2017MS08100)
内蒙古医科大学科技百万工程项目(YKD2016KJBWLH017)。
关键词
股骨骨折
动脉瘤
假性
综述
Femoral fractures
Aneurysm,false
Review
