目标:在骨科创伤中,肢体创伤合并血管损伤的识别具有挑战性。漏诊可能导致截肢甚至死亡。目的探讨体格检查联合手持血管超声多普勒检查能否成为筛查外周血管损伤的有效方法,探讨骨科创伤患者血管损伤的特点。
方法:回顾性分析我院2022年1月至2023年10月骨科创伤急诊科患者。体格检查结合手持血管超声多普勒检查作为疑似血管损伤的筛查方法。疑似血管损伤的患者将接受进一步的血管造影并接受多学科治疗。血管造影被用作诊断血管损伤的金标准。患者人口统计学,损伤机制,损伤的位置和类型,血管造影结果,手术笔记,并记录早期治疗结果数据.
结果:最终纳入疑似血管损伤的55例(58例肢体损伤)。血管造影显示53例(55肢,阳性率94.8%)被认为已确认血管损伤。男性43人(81.1%),女性10人(18.9%),平均年龄44.1±16.6岁。伤害的主要机制是交通事故(30,56.7%)。最常见的血管损伤部位为膝关节(30/55,54.5%),最常见的损伤血管是the动脉(23,47.9%)。经过多学科协作治疗,患者总死亡率为3.8%(2/53),在我们的研究中,存活患者的肢体生存率为81.1%(43/53)。
结论:在骨科创伤中,“硬体征”和“软体征”结合手持血管超声多普勒检查是筛查可疑血管损伤的有效方法。大多数四肢在血管损伤部位有相关的骨折或脱位。血管外科的合作,显微外科手术和骨科创伤可能有助于改善患者的预后。
OBJECTIVE: In orthopedic trauma, identification of extremity trauma combined with vascular injury is challenging. Missed diagnosis may result in amputation or even death. The purpose of this study was to investigate whether physical examination combined with handheld vascular ultrasound Doppler examination could be an effective method of screening for peripheral vascular injury and to explore the characteristics of vascular injuries in orthopedic trauma patients.
METHODS: Retrospective analysis of patients in the emergency department of orthopedic trauma in our hospital from January 2022 to October 2023. Physical examination combined with handheld vascular ultrasound Doppler examination was used as a screening method for suspected vascular injuries. Patients with suspected vascular injury would undergo further angiography and receive multidisciplinary treatment. Angiography was used as the gold standard for diagnosing vascular injuries. Patient demographics, mechanism of injury, location and type of injury, angiographic results, surgical notes, and early treatment outcome data were recorded.
RESULTS: A total of 55 cases (58 limb injuries) with suspected vascular injury were ultimately included. Angiography revealed that 53 cases (55 limbs, positive rate 94.8%) were considered to have confirmed vascular injuries. Forty-three were male (81.1%) and 10 were female (18.9%), with mean age 44.1 ± 16.6 years. The main mechanism of injury was traffic accident (30, 56.7%). Most common site of vascular injuries was knee joint (30/55, 54.5%), and popliteal artery (23, 47.9%) was the most commonly injured blood vessel. After multidisciplinary collaborative treatment, overall patient mortality was 3.8% (2/53), and limb survival rate among surviving patients was 81.1% (43/53) in our study.
CONCLUSIONS: In orthopedic trauma, \"Hard signs\" and \"soft signs\" combined with handheld vascular ultrasound Doppler examination were effective ways to screen for suspected vascular injuries. Most limbs had associated fractures or dislocations at the site of vascular injury. Collaboration of vascular surgery, microsurgery and orthopedic trauma may help improve patients\' prognosis.