Reichard K W, Hall J R, Meller J L, Spigos D, Reyes H M
Department of Surgery, Cook County Hospital, Chicago, IL.
J Pediatr Surg. 1994 Jan;29(1):19-22. doi: 10.1016/0022-3468(94)90515-0.
The routine use of arteriography for evaluating penetrating extremity injuries is undergoing reevaluation in the adult literature. Its role in children is less clear. Eighty-seven children treated for penetrating extremity trauma over a 5-year period were studied retrospectively to define the usefulness of arteriography. The ages ranged from 2 to 16 years. Twenty-four arteriograms were performed. Twelve were for patients who exhibited physical signs of vascular injury (diminished pulse, distal ischemia, expanding hematoma, or bruits/thrills over the wound). The other 12 were performed on asymptomatic children with wounds in proximity to major vessels. Two other patients with ongoing hemorrhage were taken directly to the operating room. Of the 12 arteriograms performed for abnormal physical signs, eight (67%) showed vascular injuries. None of the studies performed for proximity alone had abnormal results (P < .01). Ten of 10 patients with vascular injuries had abnormal physical findings, whereas only four of 77 patients without vascular injuries had abnormal findings (sensitivity 100%, specificity 95%). Eighty-five percent of patients have had follow-up in the pediatric surgery clinic, and no missed injuries or complications have been discovered. Timely diagnosis and repair is the cornerstone for successful management of vascular injuries. While the arteriogram is an important adjunct in patients who have abnormal physical findings, proximity to major vessels alone fails to identify patients at risk for significant injuries. Angiography may not be warranted in patients whose physical examination results are normal. Noninvasive modalities such as B-mode ultrasound and Doppler may have future application in the evaluation of these cases.
在成人医学文献中，用于评估四肢穿透伤的动脉造影常规应用正在重新评估。其在儿童中的作用尚不清楚。对5年内接受四肢穿透伤治疗的87名儿童进行了回顾性研究，以确定动脉造影的实用性。年龄范围为2至16岁。共进行了24次动脉造影。12次是为表现出血管损伤体征（脉搏减弱、远端缺血、血肿扩大或伤口处有杂音/震颤）的患者进行的。另外12次是对伤口靠近主要血管的无症状儿童进行的。另外两名持续出血的患者直接被送往手术室。在为有异常体征进行的12次动脉造影中，8次（67%）显示有血管损伤。仅因伤口靠近主要血管而进行的检查均无异常结果（P<0.01）。10名有血管损伤的患者中有10名有异常体征，而77名无血管损伤的患者中只有4名有异常体征（敏感性100%，特异性95%）。85%的患者在小儿外科门诊进行了随访，未发现漏诊损伤或并发症。及时诊断和修复是成功处理血管损伤的基石。虽然动脉造影在有异常体征的患者中是一项重要的辅助检查，但仅伤口靠近主要血管并不能识别有严重损伤风险的患者。对于体格检查结果正常的患者，可能无需进行血管造影。诸如B超和多普勒等非侵入性检查方法在这些病例的评估中可能有未来应用前景。
