Fayiga Y J, Valentine R J, Myers S I, Chervu A, Rossi P J, Clagett G P
Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75235.
J Vasc Surg. 1994 Sep;20(3):419-24; discussion 424-5. doi: 10.1016/0741-5214(94)90141-4.
The purpose of this study was to determine the contribution of blunt vascular trauma to death and disability in children.
We reviewed the medical records of 41 patients aged 17 years and younger requiring operative intervention for 48 blunt vascular injuries during the past 18 years.
Eight patients had arterial injuries (seven brachial, one superficial femoral) associated with orthopedic trauma resulting from falls. All eight were associated with a pulse deficit and were easily recognized. None of the eight had late sequelae after vascular repair. Thirty-three patients had vascular trauma as a result of motor vehicle crashes (n = 17), motor vehicle/pedestrian accidents (n = 12), or severe crush injuries (n = 4). Twenty-one (64%) were admitted in shock. Twenty-one major abdominal venous injuries were present in 17 patients and were lethal in 11 (65%). Abdominal venous injuries were not recognized before laparotomy. Nine of the 33 (27%) patients had extremity vascular injuries associated with orthopedic trauma, and three (9%) had major injuries of thoracic vessels. Only three patients had major abdominal arterial injuries in this series.
Vascular injuries resulting from blunt trauma are rare in the pediatric age group. Whereas blunt arterial injuries associated with long bone fractures are readily recognized, easily treated, and result in minimal late morbidity, blunt abdominal venous injuries are rarely recognized before exploration and are lethal in more than half. Devastating venous injuries are more common than arterial injuries after blunt abdominal trauma in children.
本研究的目的是确定钝性血管创伤对儿童死亡和残疾的影响。
我们回顾了过去18年中41例17岁及以下因48处钝性血管损伤而需要手术干预的患者的病历。
8例患者有与跌倒导致的骨科创伤相关的动脉损伤（7例肱动脉，1例股浅动脉）。所有8例均伴有脉搏缺损，易于识别。8例患者血管修复后均无晚期后遗症。33例患者因机动车碰撞（n = 17）、机动车/行人事故（n = 12）或严重挤压伤（n = 4）导致血管创伤。21例（64%）因休克入院。17例患者出现21处主要腹部静脉损伤，其中11例（65%）致死。剖腹手术前未发现腹部静脉损伤。33例患者中有9例（27%）有与骨科创伤相关的肢体血管损伤，3例（9%）有胸部血管的严重损伤。本系列中只有3例患者有主要腹部动脉损伤。
钝性创伤导致的血管损伤在儿童年龄组中很少见。与长骨骨折相关的钝性动脉损伤易于识别、易于治疗，且晚期发病率极低，而钝性腹部静脉损伤在探查前很少被发现，半数以上致死。儿童钝性腹部创伤后，毁灭性静脉损伤比动脉损伤更常见。
