| Objective: Popliteal Artery injury could cause blood supply stopping or decreasing of surae muscles. And the muscles would degenerate and get necrosis because of ischemia. Therefore, function of the limb could be affected for long-term ischemic contracture of muscullar tissue. Thus, it has great clinical significance to determine muscular injury extent in diagnosis and prognosis of Popliteal Artery injury. This study aims to provide a kind of index to judge the injury extent of skeletal muscle and functional prognosis of the affected limb.Presently, cases of popliteal artery injury increases gradually which often be accompanied with bone fracture, dislocation and nerve injury. However, there are rare reports about apraisals of preoperative traumatic condition and evaluation criterion of psotoperative therapeutic effect in literature retrieval. In this study, serum creatine kinase content, ischemia time, age, whether be accomanied with fractures, dislocations and nerve damage assessment were treated as indexes which could be used to appraise injury condition and predict therapeutic effects. And it provides the functional evaluation criterion of the injuried limbs after the restoration of the popliteal vessels and a comprehensive evalution in clinic.Methods: Thirty-one patients with the injury of popliteal artery be treated from December, 2007 to December, 2008 were retrospectively evaluated .1 Diagnosis and treatment: All cases were confirmed with vessel injury through operations. In operations, we explored and restored the injury of popliteal artery , popliteal vein and nerves as well as bone fractures and dislocations. We observed dynamic serum CK content before and after the operation. After operations, we gave antibiotic and hemorheologic agent. And we also debride necrotic tissues in time according with the content of serum CK, Biochemical indexes, Liver and kidney functional indexes and muscle necrotic condition. Patients who suffered from renal dysfunctional received hemodialysis with CRRT.2 Dynamic observation of serum CK: 3ml Peripheral blood was respectively sampled to measure secrum CK content about 2H,24H, 48H, 72H, 1W, and 2W before and after operations. And we should also observe injury condition of the muscles.3 The functional evaluation criterion : It was made according with the complaints of the patients and physical examination, and in reference of Maryland food rating score.4 Follow-up and evaluation: All the patients were followed up averaged 12 months (from 8 to 24 months). The contents includes the levels of ischemic contrature, muscle strength, ROM of knee joint and ankle joint, CDUS and X ray.And function of the limb were evaluated according to ZhouZhiDe limb function evaluation and The standard of limb function for restoration of the popliteal vessels.5 Statistical treatment: The CK contents of the preoperative were tested for rank-sum test with SPSS13.0. The factors which may affect therapeutic results were also treated with statistical methods : serum creatine kinase, ischemic time (from injury to recanalization of the vessels), age, whether be accompanied with fracture, dislocation nerve injury.Results:1 Serum creatine kinase dynamic testing: 14 patients were confirmed with extensive muscular injury whose CK averaged 47518 IU/L before operations, and 17 patients were confirmed with local muscular injury whose CK averaged 9351IU/L before operations. And the 2 groups had significant difference.CK of the patients with extensive muscle damage (T1) averaged 15419IU/L and the patients with local muscle damage (T2)averaged 3070IU/L. CK reached the top 24H after operations.It was 25029IU/L for group T1 and 7564IU/L for group T2. And it decreased 1w later which reached normal 2w later. CK of 5 patients 24h after the operations were more than 20,000 IU/L which lasted more than 48h. they were confirmed with extensive muscular injury which exceeded 2 muscular interspaces for the second debridement.2 Limb function follow-up results: All the patients were followed up averaged 12 months (8 ~ 24 months). All the limbs survived with functional limitation of partial limbs.Color doppler ultrasound examination results: to the final follow-up, popliteal Arteries of all the 31 patients were recanalized. radiography results: paratope and alignment of the fractures and dislocations were fine with no nonunion and osteomylitis. EMG results: 5 patients among the 7 patients did not recover significantly 6 months after the operations.3 Multi-factors analysis which affected prognosis of popliteal Artery injury: Function of the injuried limb is related with secrum CK content, ischemic time(from injury to recanalization of the vessels) and whether be accompanied with nerve injury, but it has nothing to do with age and whether be accompanied with fracture. Among all the related factors, Ck contents(got 24 hours later after operation) has the highest negative correlation with prognosis.4 Single factor analysis which affected prognosis of popliteal artery injury: functional evaluation after repair of the injuried popliteal artery is related with CK(CK contents more or less than 20000IU/L 24 hours after operation) and ischemic time(more or less than 12 hours).CK contents more than 20000IU/L got higher score than that of less than 20000IU/L while ischemic time more than 12 hours got higher score than that of less than 12 hours.5 The effect of the standard of limb function for restoration of the popliteal vessels:The standard of limb function for restoration of the popliteal vessels we used coincides with ZhouZhiDe limb function evaluation in muscle contraction and joint activity.Conclusion:1 CK could be seen as an index to check injury degree of skeletal muscle in the process of popliteal artery repair.2 Serum creatine kinase value, ischemic time, whether be accompanied with nerve damage can be used as indexes to appraise injury degree and prognosis.3 The standard of limb function for restoration of the popliteal vessels is reliable. |
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