Clinical Characteristics Of Popliteal Artery Injury In Different Planes

Purpose To investigate the risk of amputation about the affected limb in different planes of popliteal artery injury.Comparing the severity of injury of the affected limb caused by popliteal artery injury in different planes and the clinical significance of the changes in serum creatine kinase during perioperative period.Verifying the value of sural artery in repair of popliteal artery trauma.Methods Collecting 129 patients with unilateral knee joint trauma in our hospital from January 2010 to December 2019,which includs 94 patients with popliteal artery injury and 35 patients having unilateral knee joint fracture or dislocation without popliteal artery injury.The 94 patients were divided into amputation group(n=26)and non-amputation group(n=68)according to whether the limb was rescued.Using the AW Volumeshare 5 to measure and record related data according to the reconstruction results about original CTA data of the lower limbs:the L,from the bifurcation of the descending genus artery of the limb to the anterior tibial artery bifurcation in healthy limb,the S,from the blood flow interruption site to the bifurcation of the descending genus artery in affected limb.,The ratio is R=S/L.Comparing and analyzing the factors about affecting the risk of amputation in patients with popliteal artery injury.In addition,68 patients with popliteal artery injury who succeeded in limb rescue were divided into high group(16 cases)and low group(52 cases)according to whether the injury level was higher than the sural artery,the remaining 35 patients having merely unilateral knee joint fracture or dislocation were attributed to control group.comparing the creatine kinase of three groups in preoperation and postoperative 1,3,7,15 days,analying statistical data accroding to Spss23.0 and Medcalc19.3.Results(1)There were all significant differences about the S value and R value between amputation and non-amputation group(t_s=5.211,P_s<0.00;t _R=6.457,P_R<0.00),Single and Multivariate factor Logistic Regression analysis showed that:R(OR_R=0.923,P=0.015),S(OR_S=0.712,P=0.036),ischemic time(OR_i=1.237,P=0.004),combining with compartment syndrome(OR_c=5.496,P=0.044)are all independent risk factors for amputation in patients with popliteal artery injury.(2)The Receiver Operating Characteristic Curve shows:AUC_R:0.896(P<0.000,95%CI:0.816-0.949),AUC_S:0.775(P<0.000,95%CI:0.677-0.854),when the diagnostic cut-off values are 0.52mm(R)and 11.40mm(S)the diagnostic efficiency is the highest,AUC_R>AUC_S(Z=1.974,P=0.0484).(3)The CK value of high group was significantly greater than low group,low group was greater than control group(F=217.709,P<0.001),the CK value at each time point in high group was significantly different(P<0.05),there was no significant difference between preoperation and postoperative 7 day(P=0.930),postoperative 1 day and 3days(P=0.195)in low group,there are significant differences between the other time points.(4)Follow-up patient’s limb prognosis:high group are all lower than low group in pain(Z=2.488,P=0.013),function(t=-3.936,P=0.000),stability(Z=-2.231,P=0.026),mobility(Z=-2.767,P=0.006),flexion deformity(Z=-2.181,P=0.029),muscle strength(Z=-2.796,P=0.005),and total limbs(X~2=8.587,P=0.003).Conclusion(1)The level of injury may be an independent risk factor for amputation in popliteal artery injury.The higher the level of injury,the greater the risk of amputation,the higher the level of injury,the greater the risk of amputation.For every1mm that the injury plane drops,the risk of amputation is reduced to 71.2%,and for every 1%increase in the ratio R,the risk of amputation is reduced to 92.3%.(2)The level of injury plays a role in assessing the risk of amputation abut the affected limb in popliteal artery injury,the R is more reliable in assessing the diagnostic efficiency of the amputation risk about the affected limb to make amputation risk prediction compared to L.(3)The dynamic changes of serum creatine kinase can assess the severity of limb ischemia and injury in patients with PAI;It has positive significance for predicting the condition and related complications,especially preventing kidney failure.(4)The limb ischemia and injury in the high group patients were more severe than those in the low group during the perioperative period,and the dynamic changes of CK showed a sharp rise and fall trend,indicating the instability of the disease condition.(5)The prognosis of patients in low group is better than that in high.(6)The sural artery has a certain effect in repair for popliteal artery trauma.