Popliteal artery injury

　　Due to the close proximity of the popliteal artery and the bone surface of the upper femoral condyle, it is a common clinical problem that the distal end of the fracture is displaced backward due to the contraction of the gastrocnemius muscle at the posterior popliteal, causing popliteal artery injury. In addition, traumatic knee joint dislocation, condylar comminuted fracture, and blunt trauma to the popliteal fossa are also common causes in clinical practice. Attention should also be paid to iatrogenic factors, especially the misinjury of the femoral condyle during the treatment of femoral condyle fractures, which is not uncommon in clinical practice.

　　One, stab wound of the upper femoral condyle fracture

　　The upper femoral condyle is the transition area between compact bone and cancellous bone, and is often caused by traffic accidents or high-altitude falls. In the elderly, due to osteoporosis, a minor fall can cause a fracture at this site.

　　Two, strong violence leads to knee joint dislocation

　　The strong direct impact on the upper end of the tibia or the indirect force that causes the knee joint to be rotated or overextended causes the upper end of the tibia to dislocate backward and forward.

　　Three, condylar comminuted fracture

　　Generally, except for intercondylar femur fracture, most are accompanied by supracondylar or adjacent site fractures, among which those resembling T are called T-shaped fractures. The displacement of the fracture ends is often more obvious.

　　Four, sharp instrument injury can cause injury

　　Fractures with vascular nerve injury of the condyle can occur in all types of displaced fractures.

　　The blood supply of the popliteal artery should be restored within 6 to 8 hours after the injury, otherwise it may lead to limb ischemic necrosis. Therefore, early diagnosis of vascular injury is the most important factor to shorten the time between vascular injury and vascular reconstruction, and improve the prognosis. While for popliteal artery injury, some cases due to the existence of some collateral circulation or due to the early stage of popliteal artery contusion, when the blood vessels have not been completely embolized, there is still blood flow, it is still possible to feel the pulsation of the dorsalis pedis artery or the limb ischemia signs are not obvious, lack of typical signs of arterial injury. At the same time, due to the presence of fracture or dislocation, it is easy to divert attention to the fracture or dislocation, causing paresis and delaying the opportunity for surgery.

　　Postoperative complications of popliteal artery injury are prone to occur in lower leg fasciotomy syndrome, especially in those who seek medical attention late after the injury. Therefore, lower leg fasciotomy decompression surgery is one of the important means to prevent postoperative complications, which is conducive to the survival of the limb and the recovery of function.

　　The clinical symptoms of popliteal artery injury are similar to those of femoral artery involvement, mainly manifested as ischemia below the calf and weakened (or disappeared) dorsalis pedis artery pulsation; if caused by supracondylar fracture, it has the characteristic signs of such a fracture, including deformity of the lower end of the thigh, elastic fixation, severe pain, and limited activity. When the lower leg has severe blood supply insufficiency, ischemic peripheral neuritis may occur, with symptoms such as pain, hypersensitivity, and numbness.

　　Patients with popliteal artery injury should pay attention to the prevention and treatment of the lower leg myosheath syndrome. From a certain point of view, the lower leg myosheath syndrome and the involvement of the popliteal artery can be intercausal, and are prone to form a恶性循环. Therefore, it must be eliminated to prevent the aggravation of the condition.

　　According to the history of trauma, the type and characteristics of the fracture, and the clinical manifestations, it is generally not difficult to make a diagnosis. For those with difficult diagnosis, CTA or arterial angiography can be selectively adopted.

　　1. Ultrasound Examination

　　Can roughly understand the condition of the artery injury, whether there is secondary thrombosis, pseudo-aneurysm, and popliteal vein injury, etc.;

　　2. X-ray Examination

　　Can determine whether there is a fracture;

　　3. CTA or Arterial Angiography

　　Define the location of the popliteal artery injury and guide surgical treatment.

　　The treatment of patients with popliteal artery injury is very important, but diet is also very important. The specific diet is as follows:

　　1. Corn Flour Porridge

　　50g corn flour, 50g sticky rice. First, mix the corn flour with an appropriate amount of water and mix it evenly. Add the corn flour to the sticky rice when it is about to be cooked and cook it until it is thick. Take 1-2 times a day.

　　2. Sweet Porridge

　　500g fresh soy milk, 50g sticky rice. After washing the sticky rice clean, cook it with soy milk together to make porridge. Add a moderate amount of rock sugar after the porridge is done. Take 1-2 times a day.

　　3. Black Fungus Soup

　　Take 5 grams of黑木耳, soak in clean water the night before, and cook or make soup to eat the next day. Take once a day.

　　Surgical treatment is required immediately after the injury to the popliteal artery to avoid ischemic necrosis. The specific treatment is as follows:

　　1. Clear Diagnosis

　　Immediate reconstruction of the popliteal artery should be performed for all cases confirmed by angiography, including emergency treatment to minimize the ischemic time of the limb.

　　2. Suspected Arterial Injury

　　Early surgical exploration is recommended, especially for those who require surgical treatment for fractures. Time should be争取 for the reduction and internal fixation of fractures, with priority given to the exploration and repair of the popliteal artery.

　　3. Eliminate the Injury Factors

　　This mainly refers to bone and joint injuries near the course of the popliteal artery, which must strive for good reduction and stable and effective internal fixation. This is not only a requirement for the treatment of popliteal artery injury but also the primary condition for preventing secondary injury.

　　4. Cases with Popliteal Vein Injury

　　They should be repaired simultaneously to prevent secondary myointerstitial hypertension syndrome due to increased peripheral resistance.