Eddy V A
Zone 1 Penetrating Neck Injury Study Group, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA.
J Trauma. 2000 Feb;48(2):208-13; discussion 213-4. doi: 10.1097/00005373-200002000-00002.
Surgical dogma dictates that the evaluation of all penetrating zone 1 neck injuries must include arteriography to reliably exclude arterial injury requiring operation. This study was done to determine whether patients with normal findings at physical examination (PE) and on chest radiographs (CXR) really do require arteriography to identify occult, surgically important arterial injuries.
All penetrating zone 1 neck injuries in five Level I trauma centers over a 10-year period were reviewed retrospectively. Data collected included demographics, results of PE, CXR findings, other diagnostic studies done, injuries identified, need for operation, and operative findings. Arterial injury was defined as any injury to the aorta or brachiocephalic, subclavian, vertebral, or carotid arteries found on arteriography, duplex, or at operation.
Of 138 patients studied, there were 28 arterial injuries. Of the total group of 138 patients, 36 patients had normal findings at PE and on CXR. None of these 36 patients had an arterial injury. The negative predictive value of normal PE and CXR together is 100% in this series.
Patients with penetrating wounds to zone I who have no evidence of vascular injury on PE and who have normal findings on CXR may not require routine arteriography. Further study is needed to confirm these findings.
外科原则规定，对所有穿透性颈部I区损伤的评估必须包括动脉造影，以可靠地排除需要手术治疗的动脉损伤。本研究旨在确定体格检查（PE）和胸部X线片（CXR）结果正常的患者是否真的需要动脉造影来识别隐匿的、具有手术重要性的动脉损伤。
回顾性分析5个I级创伤中心10年间所有穿透性颈部I区损伤患者的资料。收集的数据包括人口统计学资料、体格检查结果、胸部X线片表现、其他诊断性检查结果、确诊的损伤、是否需要手术以及手术所见。动脉损伤定义为动脉造影、双功超声检查或手术中发现的主动脉、头臂干、锁骨下动脉、椎动脉或颈动脉的任何损伤。
在研究的138例患者中，有28例发生动脉损伤。在138例患者的总体中，36例患者体格检查和胸部X线片结果正常。这36例患者均未发生动脉损伤。在本系列研究中，体格检查和胸部X线片结果均正常的阴性预测值为100%。
I区穿透伤患者，体格检查无血管损伤证据且胸部X线片结果正常者，可能不需要常规动脉造影。需要进一步研究以证实这些发现。
