Exploration of the relationship between the level of popliteal artery injury and the risk of amputation

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Method 94 patients were divided into the amputation group (n = 26) and the nonamputation group (n = 68) based on whether limb preservation was successful. The data was reconstructed from computed tomography angiography (CTA) of the patient's lower limbs and measured using AW Volume Share 5 software. Quantify the height of the popliteal artery injury plane: that is, the distance L from the bifurcation of the descending knee artery on the healthy limb to the bifurcation of the anterior tibial artery and the distance S from the bifurcation of the descending knee artery at the site of blood flow interruption on the affected limb. Take the ratio of R = S/L, where S and R represent the height of the blood flow interruption plane. Analyze the risk factors affecting amputation in two groups of PAI patients . Result There were an significant difference between R and S between the two groups;Univariate and multivariate logistic regression analysis showed that R ( OR = 0.923, P = 0.015), S (OR = 0.712, P = 0.036), ischemic time ( OR = 1.237, P = 0.004), and concurrent fascial compartment syndrome ( OR = 5.496, P = 0.044) were all independent risk factors for amputation in PAI patients. Receiver operating characteristic curves of the subjects showed that the AUC (R, S) were 0.896 ( P < 0.000, 95% CI : 0.816–0.949) and 0.775 ( P AUC S ( Z = 1.974, P = 0.0484). Conclusion The level of injury is an independent risk factor for amputation in PAI patients, and the higher the level of injury, the greater the risk of amputation. In terms of evaluating the diagnostic efficiency of the injury plane in predicting amputation risk, R is superior to S. Popliteal artery Damage plane Risk of amputation Trauma Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 1. Background Popliteal artery injury (PAI) is a difficult-to-treat lower limb injury [1] and one of the most threatening peripheral vascular injuries [2,3]. When accompanied by severe soft tissue damage or prolonged limb ischemia, there is often a higher risk of amputation [4-7]. It is generally believed that 6-8 hours after vascular injury is the golden time for rescuing limbs. However, some patients still successfully save limbs after active surgical treatment with ischemia time far exceeding 8 hours (or even up to 48 hours). Reviewing the imaging data of such patients after injury, the lower level of vascular injury is often displayed in the arterial computed tomography angiography (CTA) of the affected limb. Careful physical examination combined with imaging examination can confirm the diagnosis of PAI [8]. Still, it is challenging to evaluate further the risk of amputation in affected limbs with similar soft tissue injuries and ischemia time. There are few reports evaluating the risk of amputation in affected limbs based on the injury level. Therefore, this article aims to compare and analyze the relevant medical records of PAI patients in each group to explore—the importance of an injury plan in assessing the risk of amputation of the affected limb. 2. Methods 2.1 General clinical characteristics of patients A retrospective analysis was conducted on 94 patients with popliteal artery injury accompanied by knee joint trauma admitted to the 904th Hospital of the Chinese People's Liberation Army Joint Logistics Support Force from January 2019 to December 2024, including 89 males and five females aged 19-70 years old. Causes of injury: 51 cases of car accident injuries, 34 cases of high-altitude falling injuries, 5 cases of cutting injuries, 3 cases of piercing injuries, and 1 case of rope-twisting injuries. There were 58 cases of closed injuries and 36 cases of open injuries. There were 47 cases of simple knee dislocation and 61 cases of combined fractures, including 18 cases of simple tibial plateau fractures (Schatzker type I 11 cases, type IV 7 cases) and 7 cases of combined fractures and dislocations. There were 21 cases of simple femoral intercondylar or supracondylar fractures and 15 cases of fractures combined with dislocations (9 cases of Hohl Moore's type and 6 cases of type III). Collect general clinical data of patients, including age, gender, height, weight, and calculate body mass index (BMI), site of injury (left and right), type of injury, presence or absence of fractures, ligament and venous injuries, Associated Injury Scale Injury Severity Score (AIS-ISS) [14], Mangled Extremity Security Score (MESS), duration of limb ischemia, etc. Based on imaging data, record L (distance from the bifurcation of the descending knee artery on the healthy limb to the bifurcation of the anterior tibial artery) and S (distance from the site of blood flow interruption on the affected limb to the bifurcation of the descending knee artery), and calculate R=S/L—inclusion criteria: ①Patients with a clear acute lower limb trauma history. ②Clearly, there are patients with unilateral popliteal artery injury accompanied by knee joint trauma who Can tolerate surgical patients. Exclusion criteria: ①Patients with extensive muscle damage to the affected limb, such as crush injuries, blast injuries, firearm injuries, etc. ②According to the Mangled Extremity Severity Score (MESS) [9-10], there are no potential limb salvage patients Except for lower limb injuries, patients with severe injuries to the head, neck, chest, abdomen, and other areas who require life-threatening rescue and unconditional limb salvage surgery for popliteal artery injuries Patients with incomplete CTA imaging data. ⑤PAI patients with other vascular lesions such as vasculitis and vascular occlusion. This experiment was approved by the Ethics Committee of the 904th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China and received informed consent from patients (March 10, 2023). 2.2 Imaging diagnosis and grouping Patients are divided into the amputation group (n=26) and the nonamputation group (n=68) based on whether limb preservation has been successful. Preoperative physical examination and CTA of the affected limb were performed to identify the site of vascular injury (Figure 1). Three-dimensional reconstruction and measurement were performed on the imaging data of the included patients using AW Volume 5: the distance L from the bifurcation of the descending knee artery to the bifurcation of the anterior tibial artery in the healthy limb and the distance S from the starting site of blood flow interruption in the affected limb to the bifurcation of the descending knee artery (Figure 2) (the length L of the popliteal artery in the affected limb cannot be measured due to blood flow interruption caused by injury; in addition, based on literature support, there is no statistically significant difference in the length of the popliteal artery in both lower limbs of the same patient [11-12]). 2.3 Surgical methods and postoperative management For PAI patients with combined fractures, after anesthesia is adequate, they should first be placed in a supine position, with airbags and tourniquets tied at the proximal thighs on both sides. Routine iodine disinfection should be performed, and sterile scarves should be laid before surgery begins. After initial debridement, external fixation or internal fixation with steel plates and screws should be used to correct fractures and dislocations around the knee joint, ensuring that the fractures are aligned and maintain a stable position of the knee joint. Change the prone position, disinfect and drape both lower limbs again, cut the wound or take an S-shaped incision of about 30cm in the popliteal area, cut the skin and subcutaneous tissue layer by layer to create a deep fascia, and explore for damage to the tibial nerve and common peroneal nerve, determine the type of popliteal artery injury, thoroughly remove inactivated soft tissue and blood clots again, trim and remove the damaged blood vessels under the microscope to make the popliteal artery intima smooth. If the length of the injury exceeds 3cm, take the great saphenous vein from the patient's healthy side for vascular transplantation and use a 9-0 non-invasive suture line for two-point bridge anastomosis. After rebuilding the blood supply, loosen the tourniquet, check if the blood vessels are unobstructed, if there is blood leakage at the anastomotic site, visually assess the activity of muscle and soft tissue, and remove muscle tissue with pale color and suspicious necrosis as much as possible to further repair damaged nerves and tendons. If high calf tension is found, perform osteofascial incision for decompression. For PAI patients without combined fractures, uncomplicated popliteal vein embolization, thrombectomy, vascular exploration and repair, and contralateral excellent saphenous vein transplantation are performed through the posterior popliteal fossa approach. After surgery, keep the affected limb in a temperature-appropriate and smoke-free environment, and maintain the knee joint in a stable position of 20 ° - 30 ° flexion. Pay attention to the color, temperature, and vascular pulsation of the affected limb, timely detect various biochemical indicators, and provide anticoagulation, spasmolysis, anti-infection, nutritional support, etc., based on the test indicators to prevent acute renal failure and compartment syndrome [13]. 2.4 Statistical analysis Statistical analysis was conducted using SPSS 20.0 and Medcalc 19.3 software. Quantitative data were expressed as mean ± standard deviation, while count data were expressed as percentages. A T-test was used to analyze intergroup differences in econometric data that met normal distribution; A rank sum test was used for econometric data that did not meet normal distribution; And counting data were all subjected to the chi-square test. Perform univariate binary logistic regression analysis on each variable and then incorporate significant variables into multivariate logistic regression analysis based on the results. Further, calculate the Odd Ratio (OR), value and 95% confidence interval ( CI ) . Perform receiver characteristic curves for S and R, evaluate the diagnostic value of injury plane on amputation risk, calculate areas under the curves ( AUC ) and 95% CI, and compare AUC S and AUC R between the two groups using the DeLong test ( P <0.05 indicates statistically significant difference). Compare the distribution of representative values S and R in the injury plane for injury types, combined fractures, and combined compartment syndrome in PAI patients. Correlation analysis was conducted to investigate the correlation between representative values R and S of the injury plane and ischemic time in PAI patients. Two-tailed or two-sided tests were used, and statistically significant differences were defined as P < 0.05. 3. Results 3.1 Comparison of baseline data between two groups of patients Among the 94 patients in this article, 26 were amputated, and 68 were successfully preserved. The total amputation rate was 27.7%, and there were no deaths. Twenty-nine cases of postoperative infections occurred, of which seven patients had delayed amputation due to limb wound infection and necrosis, and four patients had delayed amputation due to prolonged osteomyelitis; 38 cases of tissue necrosis occurred and were cured after treatment such as debridement, skin grafting, skin flap surgery, and dressing change; Fifteen cases experienced vascular crisis within 1-3 days after surgery, including eight amputations after emergency vascular exploration, and two amputations that were life-threatening due to hemorrhagic shock caused by aneurysm rupture; Some patients experienced light red gross hematuria 24 hours after surgery, which returned to normal on the third day after surgery. Among them, five patients underwent amputation due to severe renal failure. Among the successful limb salvage patients, 16 experienced foot prolapse and recovered after secondary Achilles tendon lengthening surgery. Among 61 patients with concurrent fractures of different parts, two patients had delayed fracture healing eight months after surgery and underwent secondary bone grafting and plate internal fixation before healing. The remaining patients all had primary healing. This article compares the severity of limb injuries (MESS score), ischemic time, age, gender, body mass index, injury type, systemic injury score (AIS-ISS score), inner diameter D (mm) of the affected limb blood flow interruption site, combined fractures, and combined fascial compartment syndrome in two groups of patients; Baseline data such as combined ligament injuries were subjected to intergroup difference tests (Table 1). The test results showed no significant difference in baseline data, such as ischemia time and severity of limb injury (MESS score), between the two groups of patients ( P <0.05). After removing the aforementioned confounding factors as much as possible, we explored the impact of the injury plan on the risk of amputation in PAI patients. The results showed that there was a significant difference in injury plane (S, R) between the two groups (t s =5.211), P s<0.00； t R =6.457， P R <0.00)。 3.2 Analysis results of amputation risk factors Univariate logistic regression analysis was performed on each variable (Table 2). The results showed that there were significant differences ( P <0.05) in injury type, ischemic time, combined fractures, combined fascial compartment syndrome, S, and R. After incorporating these six variables, further multivariate logistic regression analysis was performed (Table 3). The results showed that ischemic time ( OR =1.237, 95% CI : 1.070-1.431), concomitant fascial compartment syndrome ( OR =5.496, 95% CI : 1.044-28.951), distance S from the site of blood flow interruption in the affected limb to the opening of the descending knee artery ( OR =0.712, 95% CI : 0.518-0.978), and the ratio of injury distance S to the distance L from the opening of the anterior tibial artery in the healthy limb ( OR =0.923, 95% CI : 0.865-0.985) were all independent risks factors of affecting amputation in PAI patients. 3.3 Correlation analysis between injury plane and ischemic time, injury type, combined fractures, and combined compartment syndrome of bone and fascia Evaluate the correlation between a series of clinical features such as ischemia time, injury type, combined fractures, and combined fascial compartment syndrome in PAI patients and preoperative injury levels S and R (Table 4, Figures 3-5). Perform a t-test between groups before conducting correlation analysis. The results showed that S ( t t =0.328, P t =0.744; t F =0.753, P F =0.453; t O =1.874, P O =0.064), R ( t t =0.213, P t =0.832; t F =1.294, P F =0.199;t O =2.589, P O = 0.011). Pearson correlation analysis was performed on the injury plane S, R, and ischemic time, and the results showed that r R =0.453, P R <0.001, r S =0.369, P S <0.001. 3.4 Predictive efficacy of different injury planes on amputation risk in PAI patients By evaluating the diagnostic efficiency of the injury plane in predicting amputation risk through areas under the curves ( AUC ) of S and R, it was shown (Figure 6) that the areas under the curves of R and S were 0.896 ( P <0.000, 95% CI : 0.816-0.949) and 0.775 ( P S ( AUC ) ( Z =1.974, P =0.0484). The diagnostic efficiency was highest when the R and S diagnostic thresholds were 0.522 and 11.4mm, respectively. 4. Discussion The ischemic time of the affected limb after popliteal artery injury is usually considered the main factor affecting the risk of amputation. The longer the ischemic time, the more waste accumulated after anaerobic metabolism of the tissue, the more severe the degree of muscle injury and necrosis, and the higher the risk of amputation. In a study on patients with knee dislocation and popliteal artery injury, the results showed that a delay of 0.8 hours in arterial blood flow reconstruction resulted in an 85% increase in amputation rate [15]. This literature report is consistent with the statistical analysis results of this article: Logistic regression analysis was performed on each variable, and the results (Tables 2 and 3) showed that ischemic time ( OR =1.237, 95% CI : 1.070-1.431) was an independent risk factor for amputation of popliteal artery injury. The degree of soft tissue injury in the affected limb is also one of the factors that cause different amputation risks, especially large-scale muscle and soft tissue injuries (such as car accidents, crushing injuries, explosive injuries, etc.) can lead to severe microcirculation disorders, irreversible large-scale necrosis of the affected limb muscles, and often face higher amputation risks [7,16]. Most scholars believe that PAI patients who suffer from blunt injuries have more extensive damage to the lower limb vascular structure, muscle and soft tissue, bones, and ligaments, and the amputation rate is significantly higher than those who suffer from sharp injuries [1,5,7,16]. This conclusion is consistent with the statistical analysis results of this article: there is a significant difference in the types of injuries between the two groups of patients ( c 2 =5.723 a , P =0.017). Blunt injuries often mean a wider area of soft tissue damage, which is prone to early local circulation disorders, a significant accumulation of harmful substances such as lactate and inflammatory factors, and also more likely to cause fascial compartment syndrome. Poor soft tissue conditions significantly increase the risk of wound infection and other complications in the late stage. Therefore, patients with extensive muscle injuries in the affected limb, such as crushing injuries, explosive injuries, and firearm injuries, will be excluded as criteria. In addition, factors such as gender, age, and weight can also affect the amputation rate of patients to a certain extent [17-18]. Therefore, this study compared the baseline data of the two groups of patients, and the results showed that there was no significant difference in the distribution of confounding factors such as gender, age, weight, and degree of soft tissue damage (MESS) between the two groups (Table 1). Other scholars believe that the amputation rate of PAI patients is related to their preserved collateral circulation supply [19-20]. Indeed, when a patient experiences popliteal artery injury, the amount of adequate collateral circulation generated is determined by the blood flow interruption level at the time of injury. When the level of vascular injury in the affected limb is low, the central collateral circulation is not disrupted or blocked less, and blood flow can bypass the interruption site of the main popliteal artery, providing compensatory blood for the distal ischemic and hypoxic limbs. To some extent, this can reduce the pathological substances produced by anaerobic metabolism after ischemia, delay ischemic soft tissue necrosis, and minimize the degree of limb injury, thereby reducing the risk of amputation for patients. According to the experimental results of this article, univariate logistic regression analysis was performed on each variable (Tables 2 and 3), and the distance S from the site of blood flow interruption in the affected limb to the opening of the descending knee artery ( OR =0.712, 95% CI : 0.518-0.978) was determined; The ratio R ( OR =0.923, 95% CI : 0.865-0.985) between the injury distance S and the distance L from the opening of the descending knee artery to the opening of the anterior tibial artery in the healthy limb suggests that the height of the injury plane further affects or represents the number of collateral branches retained after injury, which in turn affects the amputation rate. In addition, when using the receiver operating characteristic curves( ROC) of S and R to evaluate the diagnostic efficiency of the injury plane in predicting amputation risk (Figure 6), the AUC of R and S were 0.896 ( P <0.000, 95% CI : 0.816-0.949) and 0.775 ( P <0.000, 95% CI : 0.677-0.854), respectively, which were statistically significant. Therefore, in cases of similar injuries and ischemic time, the level of injury may be another critical factor in assessing the risk of amputation in affected limbs. Currently, there is little literature supporting the view that the level of injury can affect the risk of amputation in PAI patients. Quantifying the height of the popliteal artery injury plane suggests that high-injury plane PAI patients often face higher amputation rates. The essence of S and R represents the position of blood flow interruption, and the number of adequate collateral circulation retained after injury in PAI patients almost depends on the location of blood flow interruption. The larger the S and R values, the lower the level of injury, the more collateral circulation is preserved in the affected limb, the more abundant collateral compensatory blood supply is obtained in the distal ischemic limb, the less pathological substances produced by anaerobic metabolism per unit time, and the milder the degree of soft tissue ischemia and hypoxia. It is inferred that PAI patients often face a lower risk of amputation under the premise of a similar degree of limb soft tissue injury and similar ischemic time. This conclusion is consistent with some statistical analysis results in this article; that is, a t-test comparison was conducted between the S and R scores of amputated and nonamputated patients. The results showed that there were significant differences in S and R between the two groups ( t s =5.211), P S ＜0.000;tR=6.457， P R ＜0.000）; the postoperative amputation rate of patients with high injury plane is much higher than that of patients with low injury plane. For the traditional risk factor defect time, this article conducted a correlation analysis between the quantitative indicators of injury plane R and S and the ischemic time of PAI patients. The results showed that lower R and S values were independently correlated with the risk of amputation in PAI patients. In contrast, R ( r R =0.453, P R <0.001) and S ( r S =0.369, P S <0.001) were negatively correlated with ischemic time (Figure 5). The quantitative indicators R and S are negatively correlated with the level of injury. The higher the level of injury, the less collateral circulation is retained in the distal limb after interruption of blood flow due to vascular injury (rupture, secondary embolism). This leads to the distal limb entering an ischemic and hypoxic state earlier, anaerobic metabolism produces and accumulates many harmful substances, and blood quickly enters a hypercoagulable state. Early thrombus formation further exacerbates ischemia in the affected limb, resulting in a "harmful positive feedback" regulation. Patients with such high-level injuries often experience longer distance popliteal artery thrombus during surgery, which corresponds to the traditional concept that the longer the ischemic time, the higher the risk of amputation in PAI patients [4-6]. This article explores the diagnostic efficiency of the injury plane in predicting amputation risk from another perspective by using ROC curves for S and R. The results show that the areas under the curves for R and S are 0.896 ( P <0.000, 95% CI : 0.816-0.949) and 0.775 ( P AUC S ( Z =1.974, P =0.0484), indicating that R is superior to S in evaluating amputation risk in PAI patients. Compared to S, R cleverly avoids statistical biases caused by differences in popliteal artery length and vascular variability among different patients and can be considered another reliable indicator for evaluating the risk of amputation in PAI patients. When the diagnostic thresholds for R and S are set at 0.522 and 11.4mm, respectively, the diagnostic efficiency is highest, indicating that the level of blood flow interruption is about 52.2% higher than the overall length of the affected popliteal artery. That is, when the distance between the level of blood flow interruption and the opening of the descending knee artery in the affected limb is less than 11.4mm, the risk of amputation in patients suddenly increases. This conclusion is related to the anatomical characteristics of the popliteal artery itself [21-22], that is, the opening of the internal and external sural arteries is close to the middle position of the popliteal artery as a whole [23-24], and its blood flow accounts for nearly 19% of the total collateral circulation flow of the popliteal artery [25-26], which is consistent with the statistical conclusions of this study. One of the critical factors in evaluating the risk of amputation and degree of limb ischemia in PAI patients is the inclusion of the injury plane, which supplements the judgment of clinical doctors on the severity of limb injury and ischemia in PAI patients. Among the many factors that affect the risk of amputation in this article, the statistical analysis results (Table 3) show that the injury plane is indeed an independent risk factor for amputation in the affected limb after popliteal artery injury ( OR S =0.712), P S =0.036, OR R =0.923， P R =0.015）, Further interpretation of the statistical results can be as follows: for every 1 unit (mm) decrease in the injury plane, the risk of amputation decreases to 71.2% of the original level, and for every 1% increase in R, the risk of amputation decreases to 92.3% of the original level. It is worth mentioning that the level of injury also has a specific guiding value in the selection of surgical methods. A high level of injury often means that the adequate collateral circulation of the affected limb is preserved less, the distal limb is severely ischemic, and the risk of amputation is high. It is recommended that the surgeon should strive to establish adequate circulation as soon as possible [27-30] and choose external fixation brackets to initially fix the fracture and immediately treat the blood vessels [3,31-33]. For patients with low injury planes, due to the presence of more collateral circulation to provide blood for the distal ischemic limb, the risk of amputation is relatively low. Therefore, in cases of mild contamination and acceptable soft tissue conditions, the surgeon should try to choose a one-stage fracture internal fixation surgery to facilitate early functional exercise of the knee joint after surgery [31-33]. Obtaining S and R is more objective, accurate, and easy to calculate than traditional ischemic time. From these advantages, preoperative S and R can help clinicians better evaluate the risk of amputation in PAI patients, facilitate treatment decisions, and improve patient follow-up and clinical prognosis. Shortcomings: This study has a small number of cases and is a single-center study, resulting in some data bias. In addition to considering the main confounding factors such as the Patient Injury Severity Scale (AIS-ISS), vascular diameter, degree of variation in both sides of the blood vessels, ischemic time in the affected limb, and degree of injury in the affected limb (MESS), there may also be other factors that interfere, and further exploration is needed. 5. Conclusion In conclusion, The level of popliteal artery injury is an independent risk factor for amputation in patients with popliteal artery injury, and the higher the level of vascular injury, the greater the risk of amputation in patients. In terms of evaluating the diagnostic efficiency of the injury plane in predicting amputation risk, R is superior to S. Declarations Author contributions Jianjie Mao contributed to data acquisition and analysis and drafted the manuscript; Hui Chua and Gengyang Jin contributed to the design and critically revised the manuscript. All authors gave comments and suggestions and approved the publication. Ethical approval and informed consent This study was conducted under the Declaration of Helsinki and approved by the Local Ethics Committee of the 904th Hospital of the People's Liberation Army Joint Logistic Support Force (20240623). The ethics committee waived the patients' consent, considering the study's retrospective nature. All data about the patients was anonymized or maintained confidentially. Declaration of Competing Interest No potential conflict of interest was reported by the author(s). Acknowledgments This work was supported by the Application of three-dimensional finite element analysis to investigate the relationship between the location of head and face injuries and intervertebral disc ligament complex injuries in cervical hyperextension injuries and its clinical application (M202145). Data availability statement Data from this study are available from the corresponding author upon request. References Futchko J ,Parsikia A ,Berezin N ,et al. A propensity-matched analysis of contemporary outcomes of blunt popliteal artery injury[J]. Journal of Vascular Surgery,2020,72(1):1-9. Christina T, Areg G, Jeffry N, et al. Racial Disparities in Limb Amputations After Traumatic Vascular Injury[J]. Journal of Clinical Orthopaedics and Trauma，2019,(10):100-105. Dennis, Hundersmarck,Falco, et al. Blunt popliteal artery injury following tibiofemoral trauma: vessel-first and bone-first strategy[J].Eur J Trauma Emerg Surg, 2022, 48(2): 1045-1053. Tan TW, Armstrong FD, Zhang WW. 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Tables Tab.1 Comparison of baseline data and main observation indicators between the two groups group Amputation group Non-Amputation group Test value P Age( year） 41.46±7.28 39.75±6.81 t =-1.069 0.288 BMI（kg∙m-2) 24.64±2.29 24.89±3.54 t =0.413 0.681 Ischemic time(h) 15.46±6.00 7.50±3.33 Z =-5.973 0.000 AIS-ISSscore 12.24±3.10 12.74±3.89 t =0.581 0.563 MESS-score 6.21±1.43 5.75±1.96 t =-1.246 0.218 Gender[number（%）] c 2 =0.014 0.904 male 24（92.3） 65（95.6） female 2（7.7） 3（4.4） Part[number（%）] c 2 =2.462 a 0.117 left 15（57.7） 27（39.7） right 11（42.3） 41（60.3） Type of injury[number（%）] c 2 =5.723 a 0.017 blunt 23（88.5） 43（63.2） sharp 3（11.5） 25（36.8） Open wound[number（%）] c 2 =0.000 a 0.984 open 10（38.5） 26（38.2） closed 16（61.5） 42（61.8） Combined fracture[number（%）] c 2 =3.976 a 0.046 with 21（80.8） 40（58.8） without 5（19.2） 28（41.2） Types of vascular injury[number（%）] c 2 =0.322 a 0.570 rupture 12（46.2） 27（39.7） no rupture 14（53.8） 41（60.3） Combined osteofascial syndrome[number（%）] c 2 =19.552a 0.000 with 15（57.7） 9（13.2） without 11（42.3） 59（86.8） Combined ligament injury[number（%）] c 2 =0.862 a 0.353 with 8（30.8） 28（41.2） without 18（69.2） 40（58.8） Combined vein injury[number（%）] c 2 =0.632 a 0.427 with 15（57.7） 33（48.5） without 11（42.3） 35（51.5） D（mm） 6.76±2.30 7.02±1.68 t =0.541 0.592 S（mm） 8.77±2.41 12.02±3.37 t =5.211 0.000 L（mm） 19.35±6.56 18.80±5.68 t =-0.405 0.687 R=S/L（%） 47.53±9.84 65.60±12.89 t =6.457 0.000 Note: D represents the inner diameter of the affected limb popliteal artery blood flow interruption point (mm); S is the distance (mm) from the bifurcation of the descending knee artery caused by the location of blood flow interruption in the affected limb; L is the distance from the opening of the descending knee artery on the healthy limb to the bifurcation of the anterior tibial artery (mm); R is the ratio of S to L (%). Table 2 Single-factor Logistic regression results variable B P OR 95%CI Type of injury 1.495 0.024 4.457 1.215-16.359 Ischemic time 0.312 0.000 1.367 1.211-1.543 Combined osteofascial syndrome 2.190 0.000 8.939 3.136-25.482 Combined fracture 1.078 0.052 2.940 0.990-8.730 S -0.334 0.000 0.716 0.602-0.852 R -0.143 0.000 0.867 0.814-0.924 Note: S represents the distance (mm) from the bifurcation of the descending knee artery caused by the location of blood flow interruption in the affected limb; R is the ratio of S to L (%). Table 3 Multivariate Logistic regression results variable B P OR 95%CI Type of injury 1.751 0.060 5.758 0.929-35.705 Ischemic time 0.213 0.004 1.237 1.070-1.431 Combined osteofascial syndrome 1.704 0.044 5.496 1.044-28.951 Combined fracture 1.671 0.091 5.320 0.767-36.884 S -0.340 0.036 0.712 0.518-0.978 R -0.080 0.015 0.923 0.865-0.985 Note: S represents the distance (mm) from the bifurcation of the descending knee artery caused by the location of blood flow interruption in the affected limb; R is the ratio of S to L (%). Table 4 Comparison of the distribution of injury plane S and R between injury type, combined fracture, and combined bone compartment syndrome N S （ mm ） Test value P N R=S/L （ % ） Test value P Damage type Blunt injury 66 11.05±3.25 t=0.328 0.744 66 60.39±15.04 t =0.213 0.832 Sharp injury 28 11.30±3.93 28 61.09±13.57 Fracture Combined fracture 61 10.93±3.25 t=0.753 0.453 61 59.18±15.67 t =1.294 0.199 Non-fracture 33 11.49±3.81 33 63.23±12.00 OFS Combined-OSS 24 10.00±3.65 t=1.874 0.064 24 54.16±11.74 t =2.589 0.011 Non-OSS 70 11.51±3.31 70 62.81±14.83 Note: S represents the distance (mm) from the bifurcation of the descending knee artery caused by the location of blood flow interruption in the affected limb; L is the distance from the opening of the descending knee artery on the healthy limb to the bifurcation of the anterior tibial artery (mm); R is the ratio of S to L (%), and OFS is associated with compartment syndrome of the bone fascia. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4584754","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":320700017,"identity":"e3d8a9df-17ef-4f91-b6a7-f9ab2137288b","order_by":0,"name":"Jianjie Mao","email":"","orcid":"","institution":"The 904th Hospital of Joint Logistic Support Force of PLA","correspondingAuthor":false,"prefix":"","firstName":"Jianjie","middleName":"","lastName":"Mao","suffix":""},{"id":320700018,"identity":"589501ff-5e30-4779-a16f-a5108704a8a3","order_by":1,"name":"Hui Chu","email":"","orcid":"","institution":"The 904th Hospital of Joint Logistic Support Force of PLA","correspondingAuthor":false,"prefix":"","firstName":"Hui","middleName":"","lastName":"Chu","suffix":""},{"id":320700019,"identity":"6f652c5e-628e-4943-b42a-24eeabc18271","order_by":2,"name":"GengYang Jin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYDADNmbGxgcJFTUkaOFjb242eHDmGAla5HiOt0k+bGEmrFLevfeYxM8dtQxsEoltFYkNbAz87d0JeLUYnjmXJtl75jhYy43EHTIMEmfObsCvZUaOmQRv2zGoljNsDAYSuQS0zH9jJvkXqqUgsY2ZsBZ5CR4zad62GgY2noNtDERpMeDJMbaWbTvAw8be2CyRcOYYD0G/yLefMbz5tq1OTr6Z/eHHHxU1cvztvQRsOcDAIsHAcJgHJsCDTzXElgYG5g8MDHUEFY6CUTAKRsEIBgARokbR43j9PgAAAABJRU5ErkJggg==","orcid":"","institution":"The 904th Hospital of Joint Logistic Support Force of PLA","correspondingAuthor":true,"prefix":"","firstName":"GengYang","middleName":"","lastName":"Jin","suffix":""}],"badges":[],"createdAt":"2024-06-15 04:14:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4584754/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4584754/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60353925,"identity":"55874281-2746-4d36-998b-3be6737520ba","added_by":"auto","created_at":"2024-07-15 23:47:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":478250,"visible":true,"origin":"","legend":"\u003cp\u003eOriginal 3D reconstruction image of lower limb computed tomography angiography in patients with popliteal artery injury.Indicating: The location of blood flow interruption after popliteal artery injury in the affected limb.\u003c/p\u003e","description":"","filename":"Slide1.png","url":"https://assets-eu.researchsquare.com/files/rs-4584754/v1/6a214f6f5bbb2b2f05bfc66f.png"},{"id":60353085,"identity":"7fbdef25-4a9a-4ac0-9598-3ce175f6c51b","added_by":"auto","created_at":"2024-07-15 23:39:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":240754,"visible":true,"origin":"","legend":"\u003cp\u003eThree-dimensional reconstruction of lower limb computed tomography angiography in patients with popliteal artery injury. Indications: After three-dimensional reconstruction of the lower limb under CTA in patients with popliteal artery injury, the distance from the bifurcation of the descending knee artery to the bifurcation of the anterior tibial artery in the healthy limb was measured as L (start1-V1, mm); the distance from the site of interruption of popliteal artery blood flow in the affected limb to the bifurcation of the descending knee artery was measured as S (start2-V2, mm).\u003c/p\u003e","description":"","filename":"Slide2.png","url":"https://assets-eu.researchsquare.com/files/rs-4584754/v1/b6f7d008748a24eb21755c6e.png"},{"id":60355019,"identity":"f28d130d-6afb-456b-bafb-3a0e2b337cfe","added_by":"auto","created_at":"2024-07-15 23:55:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":44070,"visible":true,"origin":"","legend":"\u003cp\u003eThe results of intergroup difference tests for the quantification index S of injury plane height in PAI patients, including injury type, osteofascial compartment syndrome, and fractures. \u003cstrong\u003ea\u003c/strong\u003e represents the difference test result of the quantitative index S of the injury plane between patients with blunt PAI and those with acute PAI. \u003cstrong\u003eb\u003c/strong\u003e represents the difference in the quantitative index S test result of the injury plane between patients with combined compartment syndrome and those without combined compartment syndrome. \u003cstrong\u003ec \u003c/strong\u003erepresents the difference test results of the quantitative index S of the injury plane between patients with combined fracture PAI and those without combined fracture PAI.\u003c/p\u003e","description":"","filename":"Slide3.png","url":"https://assets-eu.researchsquare.com/files/rs-4584754/v1/5e1890d575523221f1cf6ea5.png"},{"id":60355394,"identity":"c735f207-df84-47db-beab-781712aa2489","added_by":"auto","created_at":"2024-07-16 00:03:44","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":49228,"visible":true,"origin":"","legend":"\u003cp\u003eQuantitative indicators R for injury plane height in PAI patients: injury type, presence or absence of osteofascial compartment syndrome, and presence or absence of bone.The results of the inter-group difference test for folding. \u003cstrong\u003ea\u003c/strong\u003e represents the difference test result of the quantitative index R of the injury plane between patients with blunt PAI and patients with acute PAI. \u003cstrong\u003eb\u003c/strong\u003e represents the difference test result of the quantitative index R of the injury plane between patients with combined compartment syndrome (PAI) and those without combined compartment syndrome (PAI). \u003cstrong\u003ec\u003c/strong\u003e represents the difference test result of the quantitative index R of the injury plane between patients with combined fracture PAI and those without combined fracture PAI.\u003c/p\u003e","description":"","filename":"Slide4.png","url":"https://assets-eu.researchsquare.com/files/rs-4584754/v1/c701d9ae855cfc32926375e1.png"},{"id":60355018,"identity":"a1e96995-e7ef-4e8f-908d-4e5c4e14a0a6","added_by":"auto","created_at":"2024-07-15 23:55:44","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":71870,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation analysis between quantitative indicators R and S of injury plane height and ischemic time in PAI patients. \u003cstrong\u003ea\u003c/strong\u003e indicates that the quantitative indicator R of the injury plane in PAI patients negatively correlates with ischemic time. \u003cstrong\u003eb\u003c/strong\u003e indicates a negative correlation between the quantitative index S of the injury plane and ischemic time in PAI patients.\u003c/p\u003e","description":"","filename":"Slide5.png","url":"https://assets-eu.researchsquare.com/files/rs-4584754/v1/c73355a6137c38d6c31d797a.png"},{"id":60353082,"identity":"3c422fb8-be89-4c66-8058-b59f5f1ffc0e","added_by":"auto","created_at":"2024-07-15 23:39:44","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":61381,"visible":true,"origin":"","legend":"\u003cp\u003eQuantitative indicators R and S for the height of the injury plane, predicting the receiver operating characteristic (\u003cem\u003eROC\u003c/em\u003e) curve for amputation risk efficiency, and comparing the area under the R and S curves.\u003c/p\u003e","description":"","filename":"Slide6.png","url":"https://assets-eu.researchsquare.com/files/rs-4584754/v1/1d4812c018279c6363e58180.png"},{"id":61880209,"identity":"7fc6a0a6-7e36-4589-907b-6a532abef4c3","added_by":"auto","created_at":"2024-08-06 15:09:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1544409,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4584754/v1/b7c8f9b1-6f91-4dea-befa-c3753440089b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploration of the relationship between the level of popliteal artery injury and the risk of amputation","fulltext":[{"header":"1. Background","content":"\u003cp\u003ePopliteal artery injury (PAI) is a difficult-to-treat lower limb injury [1] and one of the most threatening peripheral vascular injuries [2,3]. When accompanied by severe soft tissue damage or prolonged limb ischemia, there is often a higher risk of amputation [4-7]. It is generally believed that 6-8 hours after vascular injury is the golden time for rescuing limbs. However, some patients still successfully save limbs after active surgical treatment with ischemia time far exceeding 8 hours (or even up to 48 hours). Reviewing the imaging data of such patients after injury, the lower level of vascular injury is often displayed in the arterial computed tomography angiography (CTA) of the affected limb. Careful physical examination combined with imaging examination can confirm the diagnosis of PAI [8]. Still, it is challenging to evaluate further the risk of amputation in affected limbs with similar soft tissue injuries and ischemia time. There are few reports evaluating the risk of amputation in affected limbs based on the injury level. Therefore, this article aims to compare and analyze the relevant medical records of PAI patients in each group to explore\u0026mdash;the importance of an injury plan in assessing the risk of amputation of the affected limb.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e2.1 General clinical characteristics of patients\u003c/p\u003e\n\u003cp\u003eA retrospective analysis was conducted on 94 patients with popliteal artery injury accompanied by knee joint trauma admitted to the 904th Hospital of the Chinese People\u0026apos;s Liberation Army Joint Logistics Support Force from January 2019 to December 2024, including 89 males and five females aged 19-70 years old. Causes of injury: 51 cases of car accident injuries, 34 cases of high-altitude falling injuries, 5 cases of cutting injuries, 3 cases of piercing injuries, and 1 case of rope-twisting injuries. There were 58 cases of closed injuries and 36 cases of open injuries. There were 47 cases of simple knee dislocation and 61 cases of combined fractures, including 18 cases of simple tibial plateau fractures (Schatzker type I 11 cases, type IV 7 cases) and 7 cases of combined fractures and dislocations. There were 21 cases of simple femoral intercondylar or supracondylar fractures and 15 cases of fractures combined with dislocations (9 cases of Hohl Moore\u0026apos;s type and 6 cases of type III). Collect general clinical data of patients, including age, gender, height, weight, and calculate body mass index (BMI), site of injury (left and right), type of injury, presence or absence of fractures, ligament and venous injuries, Associated Injury Scale Injury Severity Score (AIS-ISS)\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[14], Mangled Extremity Security Score (MESS), duration of limb ischemia, etc. Based on imaging data, record L (distance from the bifurcation of the descending knee artery on the healthy limb to the bifurcation of the anterior tibial artery) and S (distance from the site of blood flow interruption on the affected limb to the bifurcation of the descending knee artery), and calculate R=S/L\u0026mdash;inclusion criteria: ①Patients with a clear acute lower limb trauma history. ②Clearly, there are patients with unilateral popliteal artery injury accompanied by knee joint trauma who Can tolerate surgical patients. Exclusion criteria: ①Patients with extensive muscle damage to the affected limb, such as crush injuries, blast injuries, firearm injuries, etc. ②According to the Mangled Extremity Severity Score (MESS) [9-10], there are no potential limb salvage patients Except for lower limb injuries, patients with severe injuries to the head, neck, chest, abdomen, and other areas who require life-threatening rescue and unconditional limb salvage surgery for popliteal artery injuries Patients with incomplete CTA imaging data. ⑤PAI patients with other vascular lesions such as vasculitis and vascular occlusion. This experiment was approved by the Ethics Committee of the 904th Hospital of the Joint Logistics Support Force of the People\u0026apos;s Liberation Army of China and received informed consent from patients (March 10, 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.2 Imaging diagnosis and grouping\u003c/p\u003e\n\u003cp\u003ePatients are divided into the amputation group (n=26) and the nonamputation group (n=68) based on whether limb preservation has been successful. Preoperative physical examination and CTA of the affected limb were performed to identify the site of vascular injury (Figure 1). Three-dimensional reconstruction and measurement were performed on the imaging data of the included patients using AW Volume 5: the distance L from the bifurcation of the descending knee artery to the bifurcation of the anterior tibial artery in the healthy limb and the distance S from the starting site of blood flow interruption in the affected limb to the bifurcation of the descending knee artery (Figure 2) (the length L of the popliteal artery in the affected limb cannot be measured due to blood flow interruption caused by injury; in addition, based on literature support, there is no statistically significant difference in the length of the popliteal artery in both lower limbs of the same patient [11-12]).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.3 Surgical methods and postoperative management\u003c/p\u003e\n\u003cp\u003eFor PAI patients with combined fractures, after anesthesia is adequate, they should first be placed in a supine position, with airbags and tourniquets tied at the proximal thighs on both sides. Routine iodine disinfection should be performed, and sterile scarves should be laid before surgery begins. After initial debridement, external fixation or internal fixation with steel plates and screws should be used to correct fractures and dislocations around the knee joint, ensuring that the fractures are aligned and maintain a stable position of the knee joint. Change the prone position, disinfect and drape both lower limbs again, cut the wound or take an S-shaped incision of about 30cm in the popliteal area, cut the skin and subcutaneous tissue layer by layer to create a deep fascia, and explore for damage to the tibial nerve and common peroneal nerve, determine the type of popliteal artery injury, thoroughly remove inactivated soft tissue and blood clots again, trim and remove the damaged blood vessels under the microscope to make the popliteal artery intima smooth. If the length of the injury exceeds 3cm, take the great saphenous vein from the patient\u0026apos;s healthy side for vascular transplantation and use a 9-0 non-invasive suture line for two-point bridge anastomosis. After rebuilding the blood supply, loosen the tourniquet, check if the blood vessels are unobstructed, if there is blood leakage at the anastomotic site, visually assess the activity of muscle and soft tissue, and remove muscle tissue with pale color and suspicious necrosis as much as possible to further repair damaged nerves and tendons. If high calf tension is found, perform osteofascial incision for decompression. For PAI patients without combined fractures, uncomplicated popliteal vein embolization, thrombectomy, vascular exploration and repair, and contralateral excellent saphenous vein transplantation are performed through the posterior popliteal fossa approach. After surgery, keep the affected limb in a temperature-appropriate and smoke-free environment, and maintain the knee joint in a stable position of 20 \u0026deg; - 30 \u0026deg; flexion. Pay attention to the color, temperature, and vascular pulsation of the affected limb, timely detect various biochemical indicators, and provide anticoagulation, spasmolysis, anti-infection, nutritional support, etc., based on the test indicators to prevent acute renal failure and compartment syndrome [13].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.4 Statistical analysis\u003c/p\u003e\n\u003cp\u003eStatistical analysis was conducted using SPSS 20.0 and Medcalc 19.3 software. Quantitative data were expressed as mean\u0026nbsp;\u0026plusmn;\u0026nbsp;standard deviation, while count data were expressed as percentages. A T-test was used to analyze intergroup differences in econometric data that met normal distribution; A rank sum test was used for econometric data that did not meet normal distribution; And counting data were all subjected to the chi-square test. Perform univariate binary logistic regression analysis on each variable and then incorporate significant variables into multivariate logistic regression analysis based on the results. Further, calculate the Odd Ratio (OR), value and 95% confidence interval\u0026nbsp;(\u003cem\u003eCI\u003c/em\u003e)\u003cem\u003e.\u003c/em\u003e Perform receiver characteristic curves for S and R, evaluate the diagnostic value of injury plane on amputation risk, calculate areas under the curves (\u003cem\u003eAUC\u003c/em\u003e) and 95% CI, and compare\u0026nbsp;\u003cem\u003eAUC\u003c/em\u003e\u003csub\u003eS\u0026nbsp;\u003c/sub\u003eand\u0026nbsp;\u003cem\u003eAUC\u003c/em\u003e\u003csub\u003eR\u0026nbsp;\u003c/sub\u003ebetween the two groups using the DeLong test (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05 indicates statistically significant difference). Compare the distribution of representative values S and R in the injury plane for injury types, combined fractures, and combined compartment syndrome in PAI patients. Correlation analysis was conducted to investigate the correlation between representative values R and S of the injury plane and ischemic time in PAI patients. Two-tailed or two-sided tests were used, and statistically significant differences were defined as\u0026nbsp;\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e3.1 Comparison of baseline data between two groups of patients\u003c/p\u003e\n\u003cp\u003eAmong the 94 patients in this article, 26 were amputated, and 68 were successfully preserved. The total amputation rate was 27.7%, and there were no deaths. Twenty-nine cases of postoperative infections occurred, of which seven patients had delayed amputation due to limb wound infection and necrosis, and four patients had delayed amputation due to prolonged osteomyelitis; 38 cases of tissue necrosis occurred and were cured after treatment such as debridement, skin grafting, skin flap surgery, and dressing change; Fifteen cases experienced vascular crisis within 1-3 days after surgery, including eight amputations after emergency vascular exploration, and two amputations that were life-threatening due to hemorrhagic shock caused by aneurysm rupture; Some patients experienced light red gross hematuria 24 hours after surgery, which returned to normal on the third day after surgery. Among them, five patients underwent amputation due to severe renal failure. Among the successful limb salvage patients, 16 experienced foot prolapse and recovered after secondary Achilles tendon lengthening surgery. Among 61 patients with concurrent fractures of different parts, two patients had delayed fracture healing eight months after surgery and underwent secondary bone grafting and plate internal fixation before healing. The remaining patients all had primary healing. This article compares the severity of limb injuries (MESS score), ischemic time, age, gender, body mass index, injury type, systemic injury score (AIS-ISS score), inner diameter D (mm) of the affected limb blood flow interruption site, combined fractures, and combined fascial compartment syndrome in two groups of patients; Baseline data such as combined ligament injuries were subjected to intergroup difference tests (Table 1). The test results showed no significant difference in baseline data, such as ischemia time and severity of limb injury (MESS score), between the two groups of patients (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). After removing the aforementioned confounding factors as much as possible, we explored the impact of the injury plan on the risk of amputation in PAI patients. The results showed that there was a significant difference in injury plane (S, R) between the two groups (t\u003csub\u003es\u003c/sub\u003e=5.211), \u003cem\u003eP\u003c/em\u003es\u0026lt;0.00；\u003cem\u003et\u003c/em\u003e\u003csub\u003eR\u003c/sub\u003e=6.457， \u003cem\u003eP\u003c/em\u003e\u003csub\u003eR\u003c/sub\u003e\u0026lt;0.00)。\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.2 Analysis results of amputation risk factors\u003c/p\u003e\n\u003cp\u003eUnivariate logistic regression analysis was performed on each variable (Table 2). The results showed that there were significant differences (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05) in injury type, ischemic time, combined fractures, combined fascial compartment syndrome, S, and R. After incorporating these six variables, further multivariate logistic regression analysis was performed (Table 3). The results showed that ischemic time (\u003cem\u003eOR\u003c/em\u003e=1.237, 95%\u0026nbsp;\u003cem\u003eCI\u003c/em\u003e: 1.070-1.431), concomitant fascial compartment syndrome (\u003cem\u003eOR\u003c/em\u003e=5.496, 95%\u0026nbsp;\u003cem\u003eCI\u003c/em\u003e: 1.044-28.951), distance S from the site of blood flow interruption in the affected limb to the opening of the descending knee artery (\u003cem\u003eOR\u003c/em\u003e=0.712, 95%\u0026nbsp;\u003cem\u003eCI\u003c/em\u003e: 0.518-0.978), and the ratio of injury distance S to the distance L from the opening of the anterior tibial artery in the healthy limb (\u003cem\u003eOR\u003c/em\u003e=0.923, 95%\u0026nbsp;\u003cem\u003eCI\u003c/em\u003e: 0.865-0.985) were all independent risks factors of affecting amputation in PAI patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.3 Correlation analysis between injury plane and ischemic time, injury type, combined fractures, and combined compartment syndrome of bone and fascia\u003c/p\u003e\n\u003cp\u003eEvaluate the correlation between a series of clinical features such as ischemia time, injury type, combined fractures, and combined fascial compartment syndrome in PAI patients and preoperative injury levels S and R (Table 4, Figures 3-5). Perform a t-test between groups before conducting correlation analysis. The results showed that S (\u003cem\u003et\u003c/em\u003e\u003csub\u003et\u003c/sub\u003e=0.328,\u0026nbsp;\u003cem\u003eP\u003c/em\u003e\u003csub\u003et\u003c/sub\u003e=0.744;\u0026nbsp;\u003cem\u003et\u003c/em\u003e\u003csub\u003eF\u003c/sub\u003e=0.753,\u0026nbsp;\u003cem\u003eP\u003c/em\u003e\u003csub\u003eF\u003c/sub\u003e=0.453;\u0026nbsp;\u003cem\u003et\u003c/em\u003e\u003csub\u003eO\u003c/sub\u003e=1.874,\u0026nbsp;\u003cem\u003eP\u003c/em\u003e\u003csub\u003eO\u003c/sub\u003e=0.064), R (\u003cem\u003et\u003c/em\u003e\u003csub\u003et\u003c/sub\u003e=0.213,\u0026nbsp;\u003cem\u003eP\u003c/em\u003e\u003csub\u003et\u003c/sub\u003e=0.832;\u0026nbsp;\u003cem\u003et\u003c/em\u003e\u003csub\u003eF\u003c/sub\u003e=1.294,\u003cem\u003eP\u003c/em\u003e\u003csub\u003eF\u003c/sub\u003e=0.199;t\u003csub\u003eO\u003c/sub\u003e=2.589,\u003cem\u003eP\u003c/em\u003e\u003csub\u003eO\u003c/sub\u003e= 0.011). Pearson correlation analysis was performed on the injury plane S, R, and ischemic time, and the results showed that\u0026nbsp;\u003cem\u003er\u003c/em\u003e\u003csub\u003eR\u003c/sub\u003e=0.453,\u0026nbsp;\u003cem\u003eP\u003c/em\u003e\u003csub\u003eR\u003c/sub\u003e\u0026lt;0.001,\u0026nbsp;\u003cem\u003er\u003c/em\u003e\u003csub\u003eS\u003c/sub\u003e=0.369,\u0026nbsp;\u003cem\u003eP\u003c/em\u003e\u003csub\u003eS\u003c/sub\u003e\u0026lt;0.001. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.4 Predictive efficacy of different injury planes on amputation risk in PAI patients\u003c/p\u003e\n\u003cp\u003eBy evaluating the diagnostic efficiency of the injury plane in predicting amputation risk through areas under the curves (\u003cem\u003eAUC\u003c/em\u003e) of S and R, it was shown (Figure 6) that the areas under the curves of R and S were 0.896 (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.000, 95%\u0026nbsp;\u003cem\u003eCI\u003c/em\u003e: 0.816-0.949) and 0.775 (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.000, 95%\u0026nbsp;\u003cem\u003eCI\u003c/em\u003e: 0.677-0.854), respectively. The DeLong test was used for comparison: R (\u003cem\u003eAUC)\u003c/em\u003e\u0026gt;S (\u003cem\u003eAUC\u003c/em\u003e) (\u003cem\u003eZ\u003c/em\u003e=1.974,\u0026nbsp;\u003cem\u003eP\u003c/em\u003e=0.0484). The diagnostic efficiency was highest when the R and S diagnostic thresholds were 0.522 and 11.4mm, respectively.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe ischemic time of the affected limb after popliteal artery injury is usually considered the main factor affecting the risk of amputation. The longer the ischemic time, the more waste accumulated after anaerobic metabolism of the tissue, the more severe the degree of muscle injury and necrosis, and the higher the risk of amputation. In a study on patients with knee dislocation and popliteal artery injury, the results showed that a delay of 0.8 hours in arterial blood flow reconstruction resulted in an 85% increase in amputation rate\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[15]. This literature report is consistent with the statistical analysis results of this article: Logistic regression analysis was performed on each variable, and the results (Tables 2 and 3) showed that ischemic time (\u003cem\u003eOR\u003c/em\u003e=1.237, 95%\u0026nbsp;\u003cem\u003eCI\u003c/em\u003e: 1.070-1.431) was an independent risk factor for amputation of popliteal artery injury.\u003c/p\u003e\n\u003cp\u003eThe degree of soft tissue injury in the affected limb is also one of the factors that cause different amputation risks, especially large-scale muscle and soft tissue injuries (such as car accidents, crushing injuries, explosive injuries, etc.) can lead to severe microcirculation disorders, irreversible large-scale necrosis of the affected limb muscles, and often face higher amputation risks [7,16]. Most scholars believe that PAI patients who suffer from blunt injuries have more extensive damage to the lower limb vascular structure, muscle and soft tissue, bones, and ligaments, and the amputation rate is significantly higher than those who suffer from sharp injuries [1,5,7,16]. This conclusion is consistent with the statistical analysis results of this article: there is a significant difference in the types of injuries between the two groups of patients (\u003cem\u003ec\u003c/em\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=5.723\u003csup\u003ea\u0026nbsp;\u003c/sup\u003e,\u003cem\u003eP\u003c/em\u003e=0.017). Blunt injuries often mean a wider area of soft tissue damage, which is prone to early local circulation disorders, a significant accumulation of harmful substances such as lactate and inflammatory factors, and also more likely to cause fascial compartment syndrome. Poor soft tissue conditions significantly increase the risk of wound infection and other complications in the late stage. Therefore, patients with extensive muscle injuries in the affected limb, such as crushing injuries, explosive injuries, and firearm injuries, will be excluded as criteria. In addition, factors such as gender, age, and weight can also affect the amputation rate of patients to a certain extent [17-18]. Therefore, this study compared the baseline data of the two groups of patients, and the results showed that there was no significant difference in the distribution of confounding factors such as gender, age, weight, and degree of soft tissue damage (MESS) between the two groups (Table 1).\u003c/p\u003e\n\u003cp\u003eOther scholars believe that the amputation rate of PAI patients is related to their preserved collateral circulation supply [19-20]. Indeed, when a patient experiences popliteal artery injury, the amount of adequate collateral circulation generated is determined by the blood flow interruption level at the time of injury. When the level of vascular injury in the affected limb is low, the central collateral circulation is not disrupted or blocked less, and blood flow can bypass the interruption site of the main popliteal artery, providing compensatory blood for the distal ischemic and hypoxic limbs. To some extent, this can reduce the pathological substances produced by anaerobic metabolism after ischemia, delay ischemic soft tissue necrosis, and minimize the degree of limb injury, thereby reducing the risk of amputation for patients. According to the experimental results of this article, univariate logistic regression analysis was performed on each variable (Tables 2 and 3), and the distance S from the site of blood flow interruption in the affected limb to the opening of the descending knee artery (\u003cem\u003eOR\u003c/em\u003e=0.712, 95%\u0026nbsp;\u003cem\u003eCI\u003c/em\u003e: 0.518-0.978) was determined; The ratio R (\u003cem\u003eOR\u003c/em\u003e=0.923, 95%\u0026nbsp;\u003cem\u003eCI\u003c/em\u003e: 0.865-0.985) between the injury distance S and the distance L from the opening of the descending knee artery to the opening of the anterior tibial artery in the healthy limb suggests that the height of the injury plane further affects or represents the number of collateral branches retained after injury, which in turn affects the amputation rate. In addition, when using the receiver operating characteristic curves(\u003cem\u003eROC)\u0026nbsp;\u003c/em\u003eof S and R to evaluate the diagnostic efficiency of the injury plane in predicting amputation risk (Figure 6), the\u0026nbsp;\u003cem\u003eAUC\u003c/em\u003e of R and S were 0.896 (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.000, 95%\u0026nbsp;\u003cem\u003eCI\u003c/em\u003e: 0.816-0.949) and 0.775 (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.000, 95%\u0026nbsp;\u003cem\u003eCI\u003c/em\u003e: 0.677-0.854), respectively, which were statistically significant. Therefore, in cases of similar injuries and ischemic time, the level of injury may be another critical factor in assessing the risk of amputation in affected limbs. Currently, there is little literature supporting the view that the level of injury can affect the risk of amputation in PAI patients.\u003c/p\u003e\n\u003cp\u003eQuantifying the height of the popliteal artery injury plane suggests that high-injury plane PAI patients often face higher amputation rates. The essence of S and R represents the position of blood flow interruption, and the number of adequate collateral circulation retained after injury in PAI patients almost depends on the location of blood flow interruption. The larger the S and R values, the lower the level of injury, the more collateral circulation is preserved in the affected limb, the more abundant collateral compensatory blood supply is obtained in the distal ischemic limb, the less pathological substances produced by anaerobic metabolism per unit time, and the milder the degree of soft tissue ischemia and hypoxia. It is inferred that PAI patients often face a lower risk of amputation under the premise of a similar degree of limb soft tissue injury and similar ischemic time. This conclusion is consistent with some statistical analysis results in this article; that is, a t-test comparison was conducted between the S and R scores of amputated and nonamputated patients. The results showed that there were significant differences in S and R between the two groups (\u003cem\u003et\u003c/em\u003e\u003csub\u003es\u003c/sub\u003e=5.211),\u0026nbsp;\u003cem\u003eP\u003c/em\u003e\u003csub\u003eS\u003c/sub\u003e＜0.000;tR=6.457，\u003cem\u003eP\u003c/em\u003e\u003csub\u003eR\u003c/sub\u003e＜0.000）; the postoperative amputation rate of patients with high injury plane is much higher than that of patients with low injury plane.\u003c/p\u003e\n\u003cp\u003eFor the traditional risk factor defect time, this article conducted a correlation analysis between the quantitative indicators of injury plane R and S and the ischemic time of PAI patients. The results showed that lower R and S values were independently correlated with the risk of amputation in PAI patients. In contrast, R (\u003cem\u003er\u003c/em\u003e\u003csub\u003eR\u003c/sub\u003e=0.453,\u0026nbsp;\u003cem\u003eP\u003c/em\u003e\u003csub\u003eR\u003c/sub\u003e\u0026lt;0.001) and S (\u003cem\u003er\u003c/em\u003e\u003csub\u003eS\u003c/sub\u003e=0.369,\u0026nbsp;\u003cem\u003eP\u003c/em\u003e\u003csub\u003eS\u003c/sub\u003e\u0026lt;0.001) were negatively correlated with ischemic time (Figure 5). The quantitative indicators R and S are negatively correlated with the level of injury. The higher the level of injury, the less collateral circulation is retained in the distal limb after interruption of blood flow due to vascular injury (rupture, secondary embolism). This leads to the distal limb entering an ischemic and hypoxic state earlier, anaerobic metabolism produces and accumulates many harmful substances, and blood quickly enters a hypercoagulable state. Early thrombus formation further exacerbates ischemia in the affected limb, resulting in a \u0026quot;harmful positive feedback\u0026quot; regulation. Patients with such high-level injuries often experience longer distance popliteal artery thrombus during surgery, which corresponds to the traditional concept that the longer the ischemic time, the higher the risk of amputation in PAI patients\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[4-6].\u003c/p\u003e\n\u003cp\u003eThis article explores the diagnostic efficiency of the injury plane in predicting amputation risk from another perspective by using\u0026nbsp;\u003cem\u003eROC\u003c/em\u003e curves for S and R. The results show that the areas under the curves for R and S are 0.896 (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.000, 95%\u0026nbsp;\u003cem\u003eCI\u003c/em\u003e: 0.816-0.949) and 0.775 (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.000, 95%\u0026nbsp;\u003cem\u003eCI\u003c/em\u003e: 0.677-0.854), respectively (Figure 6), and a comparison is made:\u0026nbsp;\u003cem\u003eAUC\u003c/em\u003e\u003csub\u003eR\u003c/sub\u003e\u0026gt;\u003cem\u003eAUC\u003c/em\u003e\u003csub\u003eS\u0026nbsp;\u003c/sub\u003e(\u003cem\u003eZ\u003c/em\u003e=1.974,\u0026nbsp;\u003cem\u003eP\u003c/em\u003e=0.0484), indicating that R is superior to S in evaluating amputation risk in PAI patients. Compared to S, R cleverly avoids statistical biases caused by differences in popliteal artery length and vascular variability among different patients and can be considered another reliable indicator for evaluating the risk of amputation in PAI patients. When the diagnostic thresholds for R and S are set at 0.522 and 11.4mm, respectively, the diagnostic efficiency is highest, indicating that the level of blood flow interruption is about 52.2% higher than the overall length of the affected popliteal artery. That is, when the distance between the level of blood flow interruption and the opening of the descending knee artery in the affected limb is less than 11.4mm, the risk of amputation in patients suddenly increases. This conclusion is related to the anatomical characteristics of the popliteal artery itself [21-22], that is, the opening of the internal and external sural arteries is close to the middle position of the popliteal artery as a whole\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[23-24], and its blood flow accounts for nearly 19% of the total collateral circulation flow of the popliteal artery\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[25-26], which is consistent with the statistical conclusions of this study.\u003c/p\u003e\n\u003cp\u003eOne of the critical factors in evaluating the risk of amputation and degree of limb ischemia in PAI patients is the inclusion of the injury plane, which supplements the judgment of clinical doctors on the severity of limb injury and ischemia in PAI patients. Among the many factors that affect the risk of amputation in this article, the statistical analysis results (Table 3) show that the injury plane is indeed an independent risk factor for amputation in the affected limb after popliteal artery injury (\u003cem\u003eOR\u003c/em\u003e\u003csub\u003eS\u003c/sub\u003e=0.712),\u0026nbsp;\u003cem\u003eP\u003csub\u003eS\u003c/sub\u003e\u003c/em\u003e=0.036,\u003cem\u003eOR\u003c/em\u003e\u003csub\u003eR\u003c/sub\u003e=0.923，\u0026nbsp;\u003cem\u003eP\u003c/em\u003e\u003csub\u003eR\u003c/sub\u003e=0.015）, Further interpretation of the statistical results can be as follows: for every 1 unit (mm) decrease in the injury plane, the risk of amputation decreases to 71.2% of the original level, and for every 1% increase in R, the risk of amputation decreases to 92.3% of the original level. It is worth mentioning that the level of injury also has a specific guiding value in the selection of surgical methods. A high level of injury often means that the adequate collateral circulation of the affected limb is preserved less, the distal limb is severely ischemic, and the risk of amputation is high. It is recommended that the surgeon should strive to establish adequate circulation as soon as possible [27-30] and choose external fixation brackets to initially fix the fracture and immediately treat the blood vessels\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[3,31-33]. For patients with low injury planes, due to the presence of more collateral circulation to provide blood for the distal ischemic limb, the risk of amputation is relatively low. Therefore, in cases of mild contamination and acceptable soft tissue conditions, the surgeon should try to choose a one-stage fracture internal fixation surgery to facilitate early functional exercise of the knee joint after surgery [31-33].\u003c/p\u003e\n\u003cp\u003eObtaining S and R is more objective, accurate, and easy to calculate than traditional ischemic time. From these advantages, preoperative S and R can help clinicians better evaluate the risk of amputation in PAI patients, facilitate treatment decisions, and improve patient follow-up and clinical prognosis. Shortcomings: This study has a small number of cases and is a single-center study, resulting in some data bias. In addition to considering the main confounding factors such as the Patient Injury Severity Scale (AIS-ISS), vascular diameter, degree of variation in both sides of the blood vessels, ischemic time in the affected limb, and degree of injury in the affected limb (MESS), there may also be other factors that interfere, and further exploration is needed.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eIn conclusion, The level of popliteal artery injury is an independent risk factor for amputation in patients with popliteal artery injury, and the higher the level of vascular injury, the greater the risk of amputation in patients. In terms of evaluating the diagnostic efficiency of the injury plane in predicting amputation risk, R is superior to S.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJianjie Mao contributed to data acquisition and analysis and drafted the manuscript; Hui Chua and Gengyang Jin contributed to the design and critically revised the manuscript. All authors gave comments and suggestions and approved the publication. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and informed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted under the Declaration of Helsinki and approved by the Local Ethics Committee of the 904th Hospital of the People\u0026apos;s Liberation Army Joint Logistic Support Force (20240623). The ethics committee waived the patients\u0026apos; consent, considering the study\u0026apos;s retrospective nature. All data about the patients was anonymized or maintained confidentially.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo potential conflict of interest was reported by the author(s).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Application of three-dimensional finite element analysis to investigate the relationship between the location of head and face injuries and intervertebral disc ligament complex injuries in cervical hyperextension injuries and its clinical application (M202145).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData from this study are available from the corresponding author upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFutchko J ,Parsikia A ,Berezin N ,et al. 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Int J Environ Res Public Health,2016,13(8):1-12.\u003c/li\u003e\n\u003cli\u003eTalving P,Karamanos E,Skiada D,et al. Relationship of creatine kinase elevation and acute kidney injury in pediatric trauma patients[J]. Journal of Trauma \u0026amp; Acute Care Surgery,2013，74(3):912-916.\u003c/li\u003e\n\u003cli\u003eCheng QL, Cheng LL, Wang ,et al. Therapeutic management and amputation options in a long-time delayed blunt popliteal artery injury[J].Eur J Trauma Emerg Surg, 2023, 49(undefined), 0.\u003c/li\u003e\n\u003cli\u003eAreg G, Wilson SE, Nii-Kabu K, et al. Decreased National Rate of Below the Knee Amputation in Patients with Popliteal Artery Injury[J]. Annals of Vascular Surgery,2018.\u003c/li\u003e\n\u003cli\u003eLeigh A, O\u0026apos;Banion, Rachel, et al. Contemporary outcomes of traumatic popliteal artery injury repair from the popliteal scoring assessment for vascular extremity injury in trauma study[J]. J Vasc Surg, 2021, 74(5):1573-1580.\u003c/li\u003e\n\u003cli\u003eRamdass MJ, Muddeen A, Harnarayan P, et al. Risk factors associated with amputation in civilian popliteal artery trauma[J]. Injury,2018,49(6): 1188-1192.\u003c/li\u003e\n\u003cli\u003eMaithel S, Fujitani RM, Grigorian A, et al. Outcomes and Predictors of Popliteal Artery Injury in Pediatric Trauma[J]. Annals of Vascular Surgery，2020.\u003c/li\u003e\n\u003cli\u003eŁukasz, Olewnik,Piotr, et al. Variations in terminal branches of the popliteal artery: cadaveric study[J].Surg Radiol Anat, 2019, 41(12):1473-1482.\u003c/li\u003e\n\u003cli\u003eRogier HJ, Kropman, Geraldine, et al. Variations in the anatomy of the popliteal artery and its side branches[J].Vasc Endovascular Surg, 2011, 45(6):536-540.\u003c/li\u003e\n\u003cli\u003eCheng-H,Lin,Yun-H, Hsieh,et al.The Medial Sural Artery Perforator Flap in Lower Extremity Reconstruction[J].Clin Plast Surg, 2021, 48(2):249-257.\u003c/li\u003e\n\u003cli\u003eTian XN, Chao G, CongF, et al. Clinical significance of injury in different planes of popliteal vessels [J]. Chinese Journal of Orthopaedic Surgery, 2019,27 (12): 1097-1101.\u003c/li\u003e\n\u003cli\u003eCheng-H,Lin,Yun-H, Hsieh,et al.The Medial Sural Artery Perforator Flap in Lower Extremity Reconstruction[J].Clin Plast Surg, 2021, 48(2):249-257.\u003c/li\u003e\n\u003cli\u003eBahar, Yanik,Erdogan, et al.Variations of the popliteal artery branching with multidetector CT angiography[J].Surg Radiol Anat, 2014,37(3):223-30.\u003c/li\u003e\n\u003cli\u003eBarnes CJ, Pietrobon R, Higgins LD. Does the pulse examination in patients with traumatic knee dislocation predict a surgical arterial injury? A meta-analysis[J]. Trauma Inj Infect Crit Care.2002,53(6):1109\u0026ndash;1114.\u003c/li\u003e\n\u003cli\u003ePerkins ZB, Yet B, Glasgow S, et al.Meta-analysis of prognostic factors for amputation following surgical repair of lower extremity vascular trauma[J].Br J Surg. 2015,102(5):436\u0026ndash;450.\u003c/li\u003e\n\u003cli\u003eFairhurst PG, Wyss TR, Weiss S, et al. Popliteal vessel trauma: surgical approaches and the vessel-first strategy[J].Knee. 2018,25(5):849-855.\u003c/li\u003e\n\u003cli\u003eMcHenry TP, Holcomb JB, Aoki N. Fractures with major vascular injuries from gunshot wounds: implications of surgical sequence[J].Trauma. 2002,53(4):717\u0026ndash;721.\u003c/li\u003e\n\u003cli\u003eScalea TM, DuBose J, Moore EE, et al. Western Trauma Association Critical Decisions in trauma: management of the mangled extremity[J].Trauma Acute Care Surg.2012,72(1):86\u0026ndash;93.\u003c/li\u003e\n\u003cli\u003eHundersmarck D, Hietbrink F, Leenen LPH, et al. Blunt popliteal artery injury following tibiofemoral trauma:vessel-first and bone-first strategy[J].Eur J Trauma Emerg Surg.2022,48(2):1045\u0026ndash;1053.\u003c/li\u003e\n\u003cli\u003eFox N, Rajani RR, Bokhari F,et al. Evaluation and management of penetrating lower extremity arterial trauma: An eastern association for the surgery of trauma practice management. guideline[J].Trauma Acute Care Surg. 2012,73(5 SUPPL.4):315\u0026ndash;320.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTab.1 \u0026nbsp; \u0026nbsp;Comparison of baseline data and main observation indicators between the two groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"609\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003e\u003cstrong\u003egroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAmputation group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-Amputation group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eAge( year）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e41.46\u0026plusmn;7.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e39.75\u0026plusmn;6.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e=-1.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.288\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eBMI（kg∙m-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e24.64\u0026plusmn;2.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e24.89\u0026plusmn;3.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e=0.413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.681\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eIschemic time(h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e15.46\u0026plusmn;6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e7.50\u0026plusmn;3.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e=-5.973\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eAIS-ISSscore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e12.24\u0026plusmn;3.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e12.74\u0026plusmn;3.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e=0.581\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eMESS-score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e6.21\u0026plusmn;1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e5.75\u0026plusmn;1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e=-1.246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eGender[number（%）]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003ec\u003c/em\u003e\u003cem\u003e2\u003c/em\u003e=0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.904\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e24（92.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e65（95.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e2（7.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e3（4.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003ePart[number（%）]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003ec\u003c/em\u003e\u003cem\u003e2\u003c/em\u003e=2.462\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eleft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e15（57.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e27（39.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eright\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e11（42.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e41（60.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eType of injury[number（%）]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003ec\u003c/em\u003e\u003cem\u003e2\u003c/em\u003e=5.723\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eblunt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e23（88.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e43（63.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003esharp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e3（11.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e25（36.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eOpen wound[number（%）]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003ec\u003c/em\u003e\u003cem\u003e2\u003c/em\u003e=0.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.984\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eopen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e10（38.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e26（38.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eclosed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e16（61.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e42（61.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eCombined fracture[number（%）]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003ec\u003c/em\u003e\u003cem\u003e2\u003c/em\u003e=3.976\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003ewith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e21（80.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e40（58.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003ewithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e5（19.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e28（41.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eTypes of vascular injury[number（%）]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003ec\u003c/em\u003e\u003cem\u003e2\u003c/em\u003e=0.322\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.570\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003erupture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e12（46.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e27（39.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eno rupture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e14（53.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e41（60.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eCombined osteofascial syndrome[number（%）]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003ec\u003c/em\u003e\u003cem\u003e2\u003c/em\u003e=19.552a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003ewith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e15（57.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e9（13.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003ewithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e11（42.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e59（86.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eCombined ligament injury[number（%）]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003ec\u003c/em\u003e\u003cem\u003e2\u003c/em\u003e=0.862\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003ewith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e8（30.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e28（41.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003ewithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e18（69.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e40（58.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eCombined vein injury[number（%）]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003ec\u003c/em\u003e\u003cem\u003e2\u003c/em\u003e=0.632\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.427\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003ewith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e15（57.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e33（48.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003ewithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e11（42.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e35（51.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eD（mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e6.76\u0026plusmn;2.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e7.02\u0026plusmn;1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e=0.541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eS（mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e8.77\u0026plusmn;2.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e12.02\u0026plusmn;3.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e=5.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eL（mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e19.35\u0026plusmn;6.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e18.80\u0026plusmn;5.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e=-0.405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.687\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.825944170771756%\"\u003e\n \u003cp\u003eR=S/L（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.211822660098523%\"\u003e\n \u003cp\u003e47.53\u0026plusmn;9.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.495894909688012%\"\u003e\n \u003cp\u003e65.60\u0026plusmn;12.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e=6.457\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.180623973727421%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: D represents the inner diameter of the affected limb popliteal artery blood flow interruption point (mm); S is the distance (mm) from the bifurcation of the descending knee artery caused by the location of blood flow interruption in the affected limb; L is the distance from the opening of the descending knee artery on the healthy limb to the bifurcation of the anterior tibial artery (mm); R is the ratio of S to L (%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 Single-factor Logistic regression results\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.389380530973455%\"\u003e\n \u003cp\u003e\u003cstrong\u003evariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.690265486725664%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eB\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.628318584070797%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.283185840707965%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.008849557522122%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e95%CI\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.389380530973455%\"\u003e\n \u003cp\u003eType of injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.690265486725664%\"\u003e\n \u003cp\u003e1.495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.628318584070797%\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.283185840707965%\"\u003e\n \u003cp\u003e4.457\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.008849557522122%\"\u003e\n \u003cp\u003e1.215-16.359\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.389380530973455%\"\u003e\n \u003cp\u003eIschemic time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.690265486725664%\"\u003e\n \u003cp\u003e0.312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.628318584070797%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.283185840707965%\"\u003e\n \u003cp\u003e1.367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.008849557522122%\"\u003e\n \u003cp\u003e1.211-1.543\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.389380530973455%\"\u003e\n \u003cp\u003eCombined osteofascial syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.690265486725664%\"\u003e\n \u003cp\u003e2.190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.628318584070797%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.283185840707965%\"\u003e\n \u003cp\u003e8.939\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.008849557522122%\"\u003e\n \u003cp\u003e3.136-25.482\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.389380530973455%\"\u003e\n \u003cp\u003eCombined fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.690265486725664%\"\u003e\n \u003cp\u003e1.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.628318584070797%\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.283185840707965%\"\u003e\n \u003cp\u003e2.940\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.008849557522122%\"\u003e\n \u003cp\u003e0.990-8.730\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.389380530973455%\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.690265486725664%\"\u003e\n \u003cp\u003e-0.334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.628318584070797%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.283185840707965%\"\u003e\n \u003cp\u003e0.716\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.008849557522122%\"\u003e\n \u003cp\u003e0.602-0.852\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.389380530973455%\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.690265486725664%\"\u003e\n \u003cp\u003e-0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.628318584070797%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.283185840707965%\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.008849557522122%\"\u003e\n \u003cp\u003e0.814-0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote: S represents the distance (mm) from the bifurcation of the descending knee artery caused by the location of blood flow interruption in the affected limb; R is the ratio of S to L (%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3 Multivariate Logistic regression results\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.892857142857146%\"\u003e\n \u003cp\u003e\u003cstrong\u003evariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.821428571428571%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eB\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e95%CI\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.892857142857146%\" valign=\"top\"\u003e\n \u003cp\u003eType of injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e1.751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"top\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e5.758\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.929-35.705\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.892857142857146%\" valign=\"top\"\u003e\n \u003cp\u003eIschemic time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"top\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e1.237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.070-1.431\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.892857142857146%\" valign=\"top\"\u003e\n \u003cp\u003eCombined osteofascial syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e1.704\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"top\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e5.496\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.044-28.951\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.892857142857146%\" valign=\"top\"\u003e\n \u003cp\u003eCombined fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e1.671\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"top\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e5.320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.767-36.884\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.892857142857146%\" valign=\"top\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e-0.340\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"top\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e0.712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.518-0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.892857142857146%\" valign=\"top\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e-0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"top\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e0.923\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.865-0.985\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: S represents the distance (mm) from the bifurcation of the descending knee artery caused by the location of blood flow interruption in the affected limb; R is the ratio of S to L (%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 Comparison of the distribution of injury plane S and R between injury type, combined fracture, and combined bone compartment syndrome\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"672\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.581222056631892%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.84053651266766%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.687034277198212%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.114754098360656%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eS\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e（\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003emm\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e）\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.985096870342772%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTest value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.663189269746646%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7064083457526085%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.667660208643815%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eR=S/L\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e（\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e%\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e）\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.79284649776453%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTest value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.961251862891207%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.581222056631892%\"\u003e\n \u003cp\u003eDamage type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.84053651266766%\"\u003e\n \u003cp\u003eBlunt injury\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.687034277198212%\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.114754098360656%\"\u003e\n \u003cp\u003e11.05\u0026plusmn;3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.985096870342772%\"\u003e\n \u003cp\u003et=0.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.663189269746646%\"\u003e\n \u003cp\u003e0.744\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7064083457526085%\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.667660208643815%\"\u003e\n \u003cp\u003e60.39\u0026plusmn;15.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.79284649776453%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e=0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.961251862891207%\"\u003e\n \u003cp\u003e0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.581222056631892%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.84053651266766%\"\u003e\n \u003cp\u003eSharp injury\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.687034277198212%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.114754098360656%\"\u003e\n \u003cp\u003e11.30\u0026plusmn;3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.985096870342772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.663189269746646%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7064083457526085%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.667660208643815%\"\u003e\n \u003cp\u003e61.09\u0026plusmn;13.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.79284649776453%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.961251862891207%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.581222056631892%\"\u003e\n \u003cp\u003eFracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.84053651266766%\"\u003e\n \u003cp\u003eCombined fracture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.687034277198212%\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.114754098360656%\"\u003e\n \u003cp\u003e10.93\u0026plusmn;3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.985096870342772%\"\u003e\n \u003cp\u003et=0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.663189269746646%\"\u003e\n \u003cp\u003e0.453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7064083457526085%\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.667660208643815%\"\u003e\n \u003cp\u003e59.18\u0026plusmn;15.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.79284649776453%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e=1.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.961251862891207%\"\u003e\n \u003cp\u003e0.199\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.581222056631892%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.84053651266766%\"\u003e\n \u003cp\u003eNon-fracture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.687034277198212%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.114754098360656%\"\u003e\n \u003cp\u003e11.49\u0026plusmn;3.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.985096870342772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.663189269746646%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7064083457526085%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.667660208643815%\"\u003e\n \u003cp\u003e63.23\u0026plusmn;12.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.79284649776453%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.961251862891207%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.581222056631892%\"\u003e\n \u003cp\u003eOFS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.84053651266766%\"\u003e\n \u003cp\u003eCombined-OSS \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.687034277198212%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.114754098360656%\"\u003e\n \u003cp\u003e10.00\u0026plusmn;3.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.985096870342772%\"\u003e\n \u003cp\u003et=1.874\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.663189269746646%\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7064083457526085%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.667660208643815%\"\u003e\n \u003cp\u003e54.16\u0026plusmn;11.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.79284649776453%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e=2.589\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.961251862891207%\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.581222056631892%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.84053651266766%\"\u003e\n \u003cp\u003eNon-OSS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.687034277198212%\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.114754098360656%\"\u003e\n \u003cp\u003e11.51\u0026plusmn;3.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.985096870342772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.663189269746646%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7064083457526085%\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.667660208643815%\"\u003e\n \u003cp\u003e62.81\u0026plusmn;14.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.79284649776453%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.961251862891207%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: S represents the distance (mm) from the bifurcation of the descending knee artery caused by the location of blood flow interruption in the affected limb; L is the distance from the opening of the descending knee artery on the healthy limb to the bifurcation of the anterior tibial artery (mm); R is the ratio of S to L (%), and OFS is associated with compartment syndrome of the bone fascia.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Popliteal artery, Damage plane, Risk of amputation, Trauma","lastPublishedDoi":"10.21203/rs.3.rs-4584754/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4584754/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo explore the impact of different levels of popliteal artery injury (PAI) on the risk of amputation in affected limbs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethod\u003c/b\u003e\u003c/p\u003e \u003cp\u003e94 patients were divided into the amputation group (n\u0026thinsp;=\u0026thinsp;26) and the nonamputation group (n\u0026thinsp;=\u0026thinsp;68) based on whether limb preservation was successful. The data was reconstructed from computed tomography angiography (CTA) of the patient's lower limbs and measured using AW Volume Share 5 software. Quantify the height of the popliteal artery injury plane: that is, the distance L from the bifurcation of the descending knee artery on the healthy limb to the bifurcation of the anterior tibial artery and the distance S from the bifurcation of the descending knee artery at the site of blood flow interruption on the affected limb. Take the ratio of R\u0026thinsp;=\u0026thinsp;S/L, where S and R represent the height of the blood flow interruption plane. Analyze the risk factors affecting amputation in two groups of PAI patients .\u003c/p\u003e\u003cp\u003e\u003cb\u003eResult\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThere were an significant difference between R and S between the two groups;Univariate and multivariate logistic regression analysis showed that R (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.923, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015), S (OR\u0026thinsp;=\u0026thinsp;0.712, P\u0026thinsp;=\u0026thinsp;0.036), ischemic time (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.237, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), and concurrent fascial compartment syndrome (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5.496, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044) were all independent risk factors for amputation in PAI patients. Receiver operating characteristic curves of the subjects showed that the \u003cem\u003eAUC\u003c/em\u003e (R, S) were 0.896 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.000, 95% \u003cem\u003eCI\u003c/em\u003e: 0.816\u0026ndash;0.949) and 0.775 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.000, 95% \u003cem\u003eCI\u003c/em\u003e: 0.677\u0026ndash;0.854), respectively; The diagnostic efficiency is highest when the diagnostic threshold values are 0.522mm and 11.4mm, respectively; \u003cem\u003eAUC\u003c/em\u003e\u003csub\u003eR\u003c/sub\u003e\u0026gt;\u003cem\u003eAUC\u003c/em\u003e\u003csub\u003eS\u003c/sub\u003e (\u003cem\u003eZ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.974, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0484).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe level of injury is an independent risk factor for amputation in PAI patients, and the higher the level of injury, the greater the risk of amputation. In terms of evaluating the diagnostic efficiency of the injury plane in predicting amputation risk, R is superior to S.\u003c/p\u003e","manuscriptTitle":"Exploration of the relationship between the level of popliteal artery injury and the risk of amputation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-15 23:39:39","doi":"10.21203/rs.3.rs-4584754/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"def8e393-1930-48b7-9f6f-df4c5344a94e","owner":[],"postedDate":"July 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-06T15:01:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-15 23:39:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4584754","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4584754","identity":"rs-4584754","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}