目的:对上肢血管外伤(UEVT)的长期结局的民事分析是有限的。我们的目标是评估UEVT在平民创伤人群中的管理,并探索长期的功能后果。
方法:对城市一级创伤中心(2001-2022年)的UEVT患者进行了回顾性回顾和分析。分析了管理和长期功能结果。
结果:有150例UEVT患者。平均年龄34岁,85%为男性。有42%的黑人和27%的白人患者。机制穿透了79%,钝在20%,1%是多因素的。在穿透性创伤中,在30%的情况下,机制来自枪支。钝伤,27%是继发于跌倒,13%的摩托车碰撞,13%机动车碰撞,和3%的挤压伤。62%的损伤是孤立的动脉,13%的孤立静脉,并合并了25%的病例。孤立的动脉损伤包括肱动脉(34%),径向(27%),尺骨(27%),腋窝(8%),和锁骨下(4%)。大多数动脉损伤(92%)接受了自体静脉旁路(34%)的开放修复,其次是初级修复(32%),静脉补片(6.6%),和假体移植(3.3%)。有23%的人接受了筋膜切除术,其中68%是预防性的。两名患者接受了血管内介入治疗;一个接受了覆膜支架置入,另一个接受了栓塞。12%的患者围手术期再次干预。伴随损伤包括神经(35%),骨骼(17%),和韧带(16%)。45%的人需要重症监护病房入院,平均ICULOS1.6天。平均医院LOS为6.7天。严重截肢和住院死亡率分别为1.3%和4.6%。大多数(72%)的随访时间>6个月,中位随访时间为197天。创伤再入院发生率为19%。许多患者经历了慢性疼痛(56%)。以及运动(54%)和感觉(61%)缺陷。此外,41%的人日常生活活动困难。在以前雇用的患者中(57%),39%的人在重返工作岗位时经历了超过6个月的延迟。大多数患者(82%)使用阿片类药物出院;其中,16%的人在6个月时使用阿片类药物。
结论:UEVT与长期功能障碍和阿片类药物使用有关。必须在出院前咨询患者,并确保适当的随访和治疗。
OBJECTIVE: Civilian analyses of long-term outcomes of upper extremity vascular trauma (UEVT) are limited. Our goal was to evaluate the management of UEVT in the civilian trauma population and explore the long-term functional consequences.
METHODS: A retrospective review and analysis was performed of patients with UEVT at an urban Level 1 trauma center (2001-2022). Management and long-term functional outcomes were analyzed.
RESULTS: There were 150 patients with UEVT. Mean age was 34 years, and 85% were male. There were 42% Black and 27% White patients. Mechanism was penetrating in 79%, blunt in 20%, and multifactorial in 1%. Within penetrating trauma, mechanism was from firearms in 30% of cases. Of blunt injuries, 27% were secondary to falls, 13% motorcycle collisions, 13% motor vehicle collisions, and 3% crush injuries. Injuries were isolated arterial in 62%, isolated venous in 13%, and combined in 25% of cases. Isolated arterial injuries included brachial (34%), radial (27%), ulnar (27%), axillary (8%), and subclavian (4%). The majority of arterial injuries (92%) underwent open repair with autologous vein bypass (34%), followed by primary repair (32%), vein patch (6.6%), and prosthetic graft (3.3%). There were 23% that underwent fasciotomies, 68% of which were prophylactic. Two patients were managed with endovascular interventions; one underwent covered stent placement and the other embolization. Perioperative reintervention occurred in 12% of patients. Concomitant injuries included nerves (35%), bones (17%), and ligaments (16%). Intensive care unit admission was required in 45%, with mean intensive care unit length of stay 1.6 days. Mean hospital length of stay was 6.7 days. Major amputation and in-hospital mortality rates were 1.3% and 4.6% respectively. The majority (72%) had >6-month follow-up, with a median follow-up period of 197 days. Trauma readmissions occurred in 19%. Many patients experienced chronic pain (56%), as well as motor (54%) and sensory (61%) deficits. Additionally, 41% had difficulty with activities of daily living. Of previously employed patients (57%), 39% experienced a >6-month delay in returning to work. Most patients (82%) were discharged with opioids; of these, 16% were using opioids at 6 months.
CONCLUSIONS: UEVT is associated with long-term functional impairments and opioid use. It is imperative to counsel patients prior to discharge and ensure appropriate follow-up and therapy.