Schippers Sarah M, Hajewski Christina, Glass Natalie A, Caldwell Lindsey
Iowa Orthop J. 2018;38:159.
The purpose of this study was to systematically review available literature reporting vessel patency and how this correlates with cold symptoms following the treatment of a single forearm artery injury when the hand remains perfused. The outcomes of those treated by ligation were compared to those treated with vessel repair.
Electronic databases including PubMed, Embase (Elsevier) and Cochrane Central Register of Controlled Trials (Willey) were searched for studies that reported the outcomes of patients who underwent either ligation or repair of single vessel injuries to hands that remained perfused at time of presentation. Level of evidence was determined by two independent reviewers. Studies were then sorted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and application of inclusion and exclusion criteria. A total of 19 studies were included for statistical analysis. The patency of repaired vessels was calculated (with comparison between those with radial versus ulnar repair) as was the prevalence of cold symptoms in both ligation (or repairs that went on to occlusion) and repair groups.
The average patency of radial and ulnar artery repairs was 68.39% and 65.56% respectively. There was no significant difference between the success rates of these repair groups (pooled estimates for odd ratios was 1.02, p=0.867). The average incidence of cold symptoms in those who underwent ligation (or repair that when on to occlusion) and those that had patent repairs were 19.82% and 17.27% respectively. There was no significant difference between the incidence of cold symptoms between these groups (pooled estimate for proportion of patients with cold symptoms was 0.223, p=0.573).
This review showed there to be no significant difference in patency of isolated radial or ulnar artery repairs. There was also no significant difference in the prevalence of cold sensitivity in patients who underwent vessel ligation compared to those who underwent repair (and subsequently remained patent). These results support the conclusion of there being no clear benefit to attempting repair of a single vessel, although further studies are needed given the often incomplete reporting of clinical outcomes in this patient population. Additionally, though a cost-benefit analysis was not included in this review, exploring this aspect of the decision making process could be valuable.Level of Evidence: IV.
本研究的目的是系统回顾现有文献，报告单条前臂动脉损伤且手部仍有灌注时血管通畅情况以及其与感冒症状的相关性。将结扎治疗患者的结果与血管修复治疗患者的结果进行比较。
检索包括PubMed、Embase（爱思唯尔）和Cochrane对照试验中心注册库（威利）在内的电子数据库，查找报告单条手部血管损伤结扎或修复患者结果的研究，这些患者在就诊时手部仍有灌注。证据水平由两名独立评审员确定。然后根据系统评价和Meta分析的首选报告项目（PRISMA）指南以及纳入和排除标准的应用对研究进行分类。共纳入19项研究进行统计分析。计算修复血管的通畅率（比较桡动脉与尺动脉修复者）以及结扎组（或修复后闭塞者）和修复组感冒症状的发生率。
桡动脉和尺动脉修复的平均通畅率分别为68.39%和65.56%。这些修复组的成功率之间无显著差异（合并比值比估计为1.02，p = 0.867）。结扎组（或修复后闭塞者）和血管通畅修复组感冒症状的平均发生率分别为19.82%和17.27%。这些组之间感冒症状的发生率无显著差异（感冒症状患者比例的合并估计为0.223，p = 0.573）。
本综述表明，孤立的桡动脉或尺动脉修复的通畅率无显著差异。与接受血管修复（随后保持通畅）的患者相比，接受血管结扎的患者对感冒敏感的发生率也无显著差异。这些结果支持这样的结论，即尝试修复单条血管没有明显益处，尽管鉴于该患者群体临床结局报告往往不完整，还需要进一步研究。此外，尽管本综述未包括成本效益分析，但探索决策过程的这一方面可能很有价值。证据水平：IV级。
