Research progress on intraoperative and postoperative arterial injury of proximal femoral fracture
Yang Xuqing, Wang Qingxian
Emergency Center of Trauma, the Third Affiliated Hospital of Hebei Medical University, Orthopaedic Research Institution of Hebei Province, Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang 050051, China
Abstract：Objective To investigate the anatomical location, causes, diagnosis, and treatment of intraoperative and postoperative arterial injuries of proximal femoral fracture. Methods The keywords "股骨近端骨折""股骨粗隆骨折""股动脉""血管损伤""血肿""假性动脉瘤""解剖学",以及"proximal femur fracture""intertrochanteric femoral fracture""femoral artery""vascular injury""hematoma""pseudoaneurysms""anatomy" were used for the literature search on CNKI, Wanfang, CBMdisc, Web of Science, PubMed, and Embase databases. Chinese and English studies on the intraoperative and postoperative arterial injuries of proximal femoral fracture were searched from January 2000 to December 2020. Exclusion criteria were as follows: literature with no full-text available; inconsistent content; low quality; and repetitive. Thirty-five articles were finally included. The location, cause, diagnosis, and treatment of arterial injury were summarized. Results Most of the intraoperative and postoperative arterial injuries of proximal femoral fractures were located in the profunda artery system. Most of the arterial injuries were caused by iatrogenic procedures, especially accidental injury to the artery by sharp surgical instruments, and a few were caused by the displacement of the fracture fragment punctured adjacent vessels. Progressive swelling of affected limbs and uncorrectable anemia were the common clinical manifestations observed after arterial injury. Color Doppler ultrasound, CTA, and DSA helped clarify the diagnosis and guide the treatment. Conservative treatments, such as ultrasound-guided compression and thrombin injection, were suitable for small hematoma and pseudoaneurysm without compression symptoms. Surgical treatment was recommended for the following cases: pseudoaneurysms with compression symptoms; high risk of rupture; and failure of conservative treatment. Interventional therapy included coil embolization and stent implantation, which could quickly and safely seal the vascular rupture and reduce the pressure of aneurysm to a certain extent with high cost. Incision operation could completely relieve the pressure of aneurysm, but the surgical trauma was large. Conclusions Physicians should be familiar with the position of the profunda artery system and the femur, be alert to the operating instruments and surgical procedures that may damage the artery, and strictly observe the indications of surgical treatment. Continued optimization of existing surgical instruments, cultivation of good operating habits, and improvement of the performance of interventional devices need to be included in the development direction of the prevention and treatment of arterial injury in the future.
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Yang Xuqing, Wang Qingxian. Research progress on intraoperative and postoperative arterial injury of proximal femoral fracture. Chinese Journal of Anatomy and Clinics, 2022, 27(4): 291-296.
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