Colip Charles G, Gorantla Varun, LeBedis Christina A, Soto Jorge A, Anderson Stephan W
Boston University Medical Center, 840 Harrison Ave, Boston, MA, 02118, USA.
, 11 W Broadway St Unit 310, Boston, MA, 02127, USA.
Emerg Radiol. 2017 Jun;24(3):223-232. doi: 10.1007/s10140-016-1469-z. Epub 2016 Nov 29.
The purpose of this study is to assess the performance of CT angiography (CTA) in the evaluation of penetrating vascular trauma to the extremities in a large cohort of patients at our level I trauma center.
A retrospective, IRB-approved review of consecutive CTAs for the evaluation of penetrating trauma to the extremities in 446 patients (M/F = 396:50, mean age = 27 years) from 1/1/2005 to 5/1/2015 was performed. Medical records were reviewed to correlate diagnostic imaging findings with clinical history and subsequent interventions. Image quality was quantified by measurement of CT attenuation coefficients in the major arteries of the extremities. The Fisher's exact test was used to analyze the relationships between the presence and type of vascular injury and subsequent clinical management.
One hundred and thirty-one (29.4 %) of 446 patients with penetrating trauma demonstrated major vascular injury on CTA, 35 (26.7 %) of whom underwent subsequent surgical repair. None of the patients without vascular injury on CTA underwent subsequent vascular intervention. Fisher's exact test demonstrated a statistically significant difference in management and requirement for vascular repair in those patients with a vascular injury on CTA when compared to those without a vascular injury (p < 0.0001). The mean attenuation values achieved in upper and lower extremity CTAs in this population exceeded 250 HU.
Extremity CTA is found to be an accurate tool for surgical triage in patients having sustained penetrating vascular trauma.
本研究旨在评估在我们一级创伤中心的一大群患者中，CT血管造影（CTA）在评估四肢穿透性血管创伤方面的表现。
对2005年1月1日至2015年5月1日期间446例（男/女 = 396:50，平均年龄 = 27岁）因四肢穿透性创伤接受连续CTA检查的患者进行了一项经机构审查委员会批准的回顾性研究。查阅病历以将诊断性影像学结果与临床病史及后续干预措施相关联。通过测量四肢主要动脉的CT衰减系数对图像质量进行量化。采用Fisher精确检验分析血管损伤的存在及类型与后续临床处理之间的关系。
446例穿透性创伤患者中，131例（29.4%）在CTA上显示有主要血管损伤，其中35例（26.7%）随后接受了手术修复。CTA上无血管损伤的患者均未接受后续血管干预。Fisher精确检验表明，与无血管损伤的患者相比，CTA上有血管损伤的患者在处理方式及血管修复需求方面存在统计学显著差异（p < 0.0001）。该人群上肢和下肢CTA所获得的平均衰减值超过250 HU。
四肢CTA被发现是对遭受穿透性血管创伤患者进行手术分流的准确工具。
