Henderson V, Nambisan R, Smith M E, Yim K K, Organ C H
Department of Surgery, University of California, Davis-East Bay, Oakland 94602.
West J Med. 1991 Sep;155(3):253-5.
Indications for angiography in the evaluation of penetrating extremity trauma remain controversial. Our experience was reviewed to determine the yield of angiography in penetrating extremity trauma and to correlate clinical findings with angiographic results. During an 81-month period from 1983 through 1989, 284 extremity arteriograms were carried out in 268 patients. The angiographic yield in patients with abnormal clinical findings was 51%. The angiographic yield in patients when proximity of the injury to major vessels was the only indication was 6% (7% with gunshot wounds and 0% with stab wounds). Neurologic deficit alone as an indication for angiography accounted for 55% of the angiograms interpreted as "negative" and none of those interpreted as "positive". We conclude that the use of angiography in patients with gunshot wounds to the extremity with "proximity injuries" to major vessels should continue, its use is not warranted in extremity stab wounds when proximity is the sole indication, and abnormal neurologic findings in the absence of other findings are a poor predictor of vascular injury.
在评估穿透性肢体创伤时，血管造影的适应证仍存在争议。我们回顾了自身经验，以确定血管造影在穿透性肢体创伤中的诊断率，并将临床发现与血管造影结果进行关联。在1983年至1989年的81个月期间，对268例患者进行了284次肢体动脉造影。临床检查结果异常的患者中，血管造影诊断率为51%。仅以伤口靠近主要血管为指征的患者，血管造影诊断率为6%（枪伤患者为7%，刺伤患者为0%）。仅以神经功能缺损作为血管造影指征的患者中，被解读为“阴性”的血管造影占55%，而被解读为“阳性”的则无一例。我们得出结论，对于肢体枪伤且伤口“靠近”主要血管的患者，应继续使用血管造影；当仅以伤口靠近为指征时，肢体刺伤患者不适合使用血管造影；在没有其他发现的情况下，异常的神经学表现对血管损伤的预测价值不大。
