轻微钝性上肢创伤后的血管损伤：潜在“险些漏诊”损伤的识别与诊断陷阱
Vascular injuries after minor blunt upper extremity trauma: pitfalls in the recognition and diagnosis of potential "near miss" injuries.
作者信息
Bravman Jonathan T, Ipaktchi Kyros, Biffl Walter L, Stahel Philip F
机构信息
Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA.
出版信息
Scand J Trauma Resusc Emerg Med. 2008 Nov 25;16:16. doi: 10.1186/1757-7241-16-16.
BACKGROUND
Low energy trauma to the upper extremity is rarely associated with a significant vascular injury. Due to the low incidence, a high level of suspicion combined with appropriate diagnostic algorithms are mandatory for early recognition and timely management of these potentially detrimental injuries.
METHODS
Review of the pertinent literature, supported by the presentation of two representative "near miss" case examples.
RESULTS
A major diagnostic pitfall is represented by the insidious presentation of significant upper extremity arterial injuries with intact pulses and normal capillary refill distal to the injury site, due to collateral perfusion. Thus, severe vascular injuries may easily be missed or neglected at the upper extremity, leading to a long-term adverse outcome with the potential need for a surgical amputation.
CONCLUSION
The present review article provides an outline of the diagnostic challenges related to these rare vascular injuries and emphasizes the necessity for a high level of suspicion, even in the absence of a significant penetrating or high-velocity trauma mechanism.
背景
上肢低能量创伤很少伴有严重的血管损伤。由于发病率低，高度怀疑并结合适当的诊断算法对于早期识别和及时处理这些潜在的有害损伤至关重要。
方法
回顾相关文献，并展示两个具有代表性的“险些发生意外”病例。
结果
主要的诊断陷阱是，由于侧支循环灌注，上肢严重动脉损伤在损伤部位远端脉搏完整且毛细血管再充盈正常时隐匿出现。因此，上肢严重血管损伤很容易被漏诊或忽视，导致长期不良后果，可能需要手术截肢。
结论
本综述文章概述了与这些罕见血管损伤相关的诊断挑战，并强调即使在没有明显穿透性或高速创伤机制的情况下，也有必要高度怀疑。
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