Chloros George D, Lucas Robert M, Li Zhongyu, Holden Martha B, Koman L Andrew
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
J Hand Surg Am. 2008 Jul-Aug;33(6):932-40. doi: 10.1016/j.jhsa.2008.02.011.
Treatment of posttraumatic symptomatic ulnar artery thrombosis (UAT) is controversial. This study reports the outcome at 2 years minimum follow-up of a uniform approach using reversed interpositional vein grafting to treat symptomatic patients with UAT.
The records of all patients with vascular disease of the upper extremity who were revascularized at the authors' institution were retrospectively reviewed, and the following inclusion criteria were applied: (1) arteriographically proven UAT treated with excision of the involved segment and reversed interpositional vein grafting; (2) absence of collagen vascular disease, coagulopathy, or peripheral vascular disease, (3) minimum follow-up of 24 months. Twelve patients (13 hands) were identified and evaluated before surgery and at final follow-up using the following health-related quality of life outcome instruments: (1) McCabe cold sensitivity severity scale, (2) McGill visual analog pain scale, (3) Levine symptom and function scale, and (4) Wake Forest University symptom scale (pain, numbness, and cold intolerance). Digital microvascular perfusion testing (laser Doppler perfusion imaging and isolated cold stress testing) was also performed, and the final test was compared with 28 normal controls. All patients were evaluated for graft patency as determined by Allen's testing and/or Doppler ultrasound.
Ten of the 13 grafts were patent at final follow-up (77% patency rate). In all the patients with patent grafts, the Levine symptom scale, the McGill visual analog pain scale, the McCabe cold sensitivity severity scale, and the isolated cold stress testing responses of the patients were significantly improved at final follow-up. Isolated cold stress testing responses were not different from those of normal controls. The changes in the Levine function scale, Wake Forest University scale, and laser Doppler perfusion imaging were not significant. In the nonpatent grafts (3 of 13), 2 patients still complained of pain, numbness, and cold sensitivity, whereas 1 patient has minimal symptoms and continues to improve.
Successful arterial reconstruction in symptomatic posttraumatic UAT decreases symptoms, improves function and microvascular physiology, and has a positive effect on the health-related quality of life.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
创伤后有症状的尺动脉血栓形成（UAT）的治疗存在争议。本研究报告了采用逆行静脉移植术治疗有症状的UAT患者的统一方法，至少随访2年的结果。
回顾性分析在作者所在机构接受血管重建的所有上肢血管疾病患者的记录，并应用以下纳入标准：（1）经动脉造影证实的UAT，采用切除受累节段并进行逆行静脉移植术治疗；（2）无胶原血管疾病、凝血障碍或周围血管疾病；（3）至少随访24个月。确定了12例患者（13只手），并在手术前和最终随访时使用以下与健康相关的生活质量结局指标进行评估：（1）麦凯布冷敏感严重程度量表；（2）麦吉尔视觉模拟疼痛量表；（3）莱文症状和功能量表；（4）维克森林大学症状量表（疼痛、麻木和冷不耐受）。还进行了数字微血管灌注测试（激光多普勒灌注成像和孤立冷应激测试），并将最终测试结果与28名正常对照者进行比较。所有患者均通过艾伦试验和/或多普勒超声评估移植血管的通畅情况。
13例移植血管中有10例在最终随访时通畅（通畅率77%）。在所有移植血管通畅的患者中，最终随访时患者的莱文症状量表、麦吉尔视觉模拟疼痛量表、麦凯布冷敏感严重程度量表以及孤立冷应激测试反应均有显著改善。孤立冷应激测试反应与正常对照者无异。莱文功能量表、维克森林大学量表和激光多普勒灌注成像的变化不显著。在移植血管不通畅的患者中（13例中的3例），2例患者仍抱怨疼痛、麻木和冷敏感，而1例患者症状轻微并持续改善。
有症状的创伤后UAT成功进行动脉重建可减轻症状、改善功能和微血管生理，并对与健康相关的生活质量产生积极影响。
研究类型/证据水平：治疗性IV级。
