Bergstein J M, Blair J F, Edwards J, Towne J B, Wittmann D H, Aprahamian C, Quebbeman E J
Department of Surgery, Medical College of Wisconsin, Milwaukee.
J Trauma. 1992 Sep;33(3):395-402. doi: 10.1097/00005373-199209000-00010.
We compared color-flow duplex ultrasonographic scanning (CFD) to arteriography in 67 patients who sustained 75 penetrating injuries to the extremities without obvious arterial injury. There were 72 negative and three (4.0%) positive CFD studies and no failed attempts. With arteriography as the "gold standard," CFD had a specificity of 99% and a sensitivity of 50%, positive and negative predictive values of 66% and 97%, and an accuracy of 96%. Small pseudoaneurysms were missed in an axillary and an aberrant radial artery, and a genicular artery pseudoaneurysm was misread as originating from the popliteal artery. Cautious interpretation of negative studies appears warranted, particularly in the axilla and in bifurcated arteries. Extremity arteries should be completely imaged to rule out aberrant anatomy. Questionable studies should be confirmed arteriographically. With these caveats, color-flow duplex scanning may be useful for screening extremities with penetrating injuries thought to harbor occult arterial injuries.
我们对67例四肢遭受75处穿透伤且无明显动脉损伤的患者进行了彩色血流双功超声扫描（CFD）与动脉造影的比较。CFD检查结果为72例阴性，3例（4.0%）阳性，且无检查失败的情况。以动脉造影作为“金标准”，CFD的特异性为99%，敏感性为50%，阳性和阴性预测值分别为66%和97%，准确性为96%。腋窝处的一条腋动脉和一条异常桡动脉中的小假性动脉瘤被漏诊，一个膝部动脉假性动脉瘤被误判为起源于腘动脉。对于阴性检查结果，尤其是在腋窝和分叉动脉处，似乎需要谨慎解读。应完整成像四肢动脉以排除异常解剖结构。可疑的检查结果应通过动脉造影进行确认。考虑到这些注意事项，彩色血流双功扫描可能有助于筛查被认为存在隐匿性动脉损伤的穿透伤四肢。
