Rose S C, Moore E E
Department of Radiology, Denver General Hospital, Colorado.
J Trauma. 1988 Feb;28(2):240-5.
Two-hundred eighty angiographic studies performed for suspected acute arterial trauma were reviewed to evaluate the relationship between the clinical findings and arterial injury. Extremity injury occurred in 237 cases. The proximity of a penetrating injury or a fracture to a major vascular structure was the sole indication for angiographic study in 136. No major arterial injury was discovered in either group. Exclusion of these patients would have improved the extremity angiographic yield from 25% to 58% while missing no patients with major arterial injury. We conclude, based on the negligible yield, that clinical observation of these patients is a safe alternative if adequate followup is assured; elective angiography may be performed if followup is questionable. Nineteen of 20 (95%) patients with an absent distal pulse and clinical signs of extremity ischemia had a major arterial injury. All extremity arterial injuries occurred within 5 cm of bullet fragments, bone fragments, entrance wound, or exit wound. Given the virtual assurance of finding major arterial injury, patients with unifocal injury and a threatened limb may proceed directly to the operating room to minimize ischemic time.
回顾了280例因疑似急性动脉创伤而进行的血管造影研究，以评估临床发现与动脉损伤之间的关系。237例发生肢体损伤。在136例中，穿透伤或骨折靠近主要血管结构是进行血管造影研究的唯一指征。两组均未发现重大动脉损伤。排除这些患者会使肢体血管造影的阳性率从25%提高到58%，同时不会遗漏任何有重大动脉损伤的患者。基于可忽略不计的阳性率，我们得出结论，如果能确保充分的随访，对这些患者进行临床观察是一种安全的选择；如果随访情况存疑，可以进行选择性血管造影。20例远端脉搏消失且有肢体缺血临床体征的患者中有19例（95%）存在重大动脉损伤。所有肢体动脉损伤均发生在距子弹碎片、骨碎片、入口伤口或出口伤口5厘米范围内。鉴于几乎可以肯定会发现重大动脉损伤，单灶损伤且肢体受到威胁的患者可直接进入手术室，以尽量缩短缺血时间。
