下肢动脉损伤MSCTA诊断及误诊漏诊原因分析

目的 研究64层螺旋CT血管成像在下肢动脉损伤诊断中的应用价值及误诊漏诊原因.方法 回顾性分析30例下肢动脉损伤的下肢动脉多层螺旋CT血管成像(MSCTA)图像,运用各种图像后处理技术分析动脉损伤情况,并与数字减影血管造影(DSA)或手术探查结果对比.结果 30例患者中有动脉闭塞36处,动脉断裂14处,动脉狭窄52处,假性动脉瘤10处,动静脉瘘4处.MSCTA诊断下肢动脉损伤的结果与DSA或手术探查结果对比,诊断符合率为94.78％.结论 MSCTA可直观、准确地显示下肢动脉损伤情况.各种后处理技术中,MPR/CPR对下肢动脉损伤显示最佳,VR对手术定位有很好的辅助作用.     

四肢主要动脉闭合性损伤15例的早期诊治

我科1988～1992年间共收治早期四肢主要动脉损伤67例，其中闭合性损伤15例，占22．4％。我们现就其．早期诊治问题进行总结。临床资料一、一住情况本组男12例，女3例；年龄ZI～4O岁．平均29．6岁。受伤距就诊时间lh～sd．其中6，～12hll例．占73．3％。肢体缺血时间；小于12h6例，大于12h9例。受伤原因：辗压伤7例，汽车撞伤3例，重物砸伤3例．高处坠落伤2例。血管损伤部位及程度：股动脉6例，胶动脉5例，脑动脉3例，腋动脉1例；血管内膜损伤伴血栓形成7例，动脉不全断离5例．完全断离3例。合并伤：严重软组织挫伤13例，骨折12例，神经损…     

单纯闭合性腘动脉钝性损伤

目的 探讨单纯闭合性腘动脉钝性损伤的诊治方法。方法 自1984年3月至2002年11月共收治单纯闭合性腘动脉钝性损伤11例。所有患者无膝关节周围骨折及关节脱位，腘动脉均系钝性损伤。结合 受伤情况及临床检查以及多普勒超声检查，早期诊断，早期仔细修复损伤的血管，术中、术后抗凝治疗，以及术中预防性筋膜切开减压、预防感染等综合治疗。结果 1例截肢，2例有轻度跛行，但日常生活无明显影响；1例因初次术后吻合口处血栓形成二次手术者，发生缺血性肌坏死虽保住了肢体，但遗留有严重的肢体功能障碍。结论 单纯闭合性腘动脉钝性损伤应早期采取相关检查，及时明确诊断并积极采取手术等综合治疗，降低并发症发生率和截肢率。     

四肢主要动脉损伤的诊断及治疗

回顾 93例四肢主要动脉损伤的诊断及治疗 ,认为早期诊断、及时手术修复并辅以深筋膜切开减张及高压氧治疗能有效地救治四肢主要动脉损伤 ,减少其死亡率及致残率。     

钝性闭合性手损伤致动脉危象17例

手指动脉细小 ,断指再植或动脉修复术后发生动脉危象较为常见。 1995～ 1999年 ,我们收治钝性闭合性手指损伤 386例 4 14指 ,其中 17例 19指发生动脉危象。1　临床资料1 1　一般情况　本组男 12例 13指 ,女 5例 6指 ;年龄 13～ 67岁 ,平均 2 8 9岁。致伤原因 :重物砸伤6例 7指 ,挤压伤 4例 5指 ,钝器砍伤 3例 3指 ,爆炸伤 2例 2指 ,绳索勒伤 2例 2指。伤情诊断 :指骨闭合性骨折 10例 10指 ,掌骨闭合性骨折合并软组织挫伤 1例 3指 ,手指软组织挫伤 6例 6指。伤后至出现动脉危象时间 :1ｄ 6例 7指 ,2～ 6ｄ 11例 12指。伤后先期处理 :3例指骨…     

创伤后四肢主干动脉血管损伤184例救治分析

四肢主干动脉血管的急性损伤程度直接影响着肢体的血液循环及预后,其救治的关键在于血管复通时限。一般认为,     

钢筋穿刺致腹部开放性损伤11例

钢筋穿刺致腹部损伤是一种开放性腹部损伤,常造成腹腔内多脏器损伤、大血管损伤,引起脏器破裂、失血性休克、腹腔感染等严重并发症.此类创伤往往损伤严重、病情复杂,如不及时救治,可危及患者生命.笔者采用回顾性病例系列研究分析2011年10月至2018年11月解放军联勤保障部队第九〇〇医院收治的11例钢筋致腹部损伤患者的临床资料...     

创伤性四肢主干血管损伤24例的诊断和治疗

交通、刀刺或意外等事故所致肢体骨折、脱位、挫伤、挤压等伤害,常合并主干血管开放性或闭合性损伤.如何在肢体缺血安全期内重建与恢复血流循环,是创伤外科医师所面临的迫切挑战之一.我院1997年7月-2009年5月共收治24例四肢主干血管损伤,治疗效果满意,现报告如下.     

MSCTA诊断下肢动脉闭塞性疾病

目的：探讨16层螺旋CT对下肢动脉闭塞性疾病的诊断价值。方法：对40例临床可疑外周动脉闭塞性疾病的患者行下肢动脉16层螺旋CT血管成像,其中30例患者于CTA检查前或后两周内行DSA检查,以DSA为金标准,评价CTA诊断的准确性。结果：CTA诊断下肢动脉狭窄（≥50%）的敏感度为95.56%（129/135）,特异度为98.20%（545/555）,符合率97.68%（674/690）,阳性预测值98.88%（176/178）,阴性预测值99.61%（512/514）。结论：16层螺旋CT对诊断下肢动脉闭塞性疾病有较高的敏感性、特异性和准确性,可部分替代DSA检查。     

三维对比增强MRA对四肢创伤性动脉损伤的诊断价值

目的 探讨三维对比增强磁共振血管造影(3D CE-MRA)对四肢创伤性动脉损伤的诊断价值.方法 回顾性分析30例四肢创伤性动脉损伤患者的3D CE-MRA影像学资料,并与手术探查结果进行对比.结果 30例患者中,动脉断裂3例,动脉部分裂伤6例(合并有假性动脉瘤5例和动静脉瘘1例),动脉挫伤(动脉内膜挫伤并血栓)12例,动脉胁迫征9例(完全动脉胁迫征4例和部分动脉胁迫征5例);3D CE-MRA诊断正确27例,另3例不能鉴别动脉损伤类型.结论 3D CE-MRA能清楚诊断四肢动脉损伤的部位和类型,对治疗方案的选择具有重要的指导作用,可作为四肢创伤性动脉损伤患者的常规检查方法.     

Noncovered stent placement in a blunt traumatic injury of the right subclavian artery

We report a case of scapulothoracic dissociation with right subclavian artery traumatic injury that was managed by endovascular treatment. Particular features are the use of a flexible self-expandable noncovered stent and simultaneous protection of the right common carotid artery from distal embolization by inflating a balloon catheter.     

Trauma angiography of the extremity: The impact of injury mechanism on triage decisions

A review of angiographic studies of 227 consecutive injured patients suspected of having sustained extremity arterial trauma was done to determine whether knowledge of the mechanisms of injury was of use in the establishment of priority in multiply injured patients. Stab wounds and other lacerations occurred in 32 patients. Major arterial injury occurred in only 3 (12%) cases; in no case was arterial occlusion present or limb viability threatened. These injuries may be angiographically evaluated on a nonurgent basis. Alternatively, patients with gunshot wounds (130 patients) and blunt injuries (63 patients) had a high incidence of major arterial injury (18 and 38%, respectively), especially arterial occlusion (15 and 24%, respectively) as well as a significant incidence of threatened limb viability (5 and 21%, respectively). Disproportionately increased risk of arterial injury occurred in patients with high-energy gunshot wounds (75%), motorcycle accidents (62%), and crush injuries (63%). Patients who sustain gunshot wounds or blunt injuries and have an abnormal vascular physical examination should be evaluated angiographically on an urgent basis.     

Diagnosis of blunt traumatic aortic injury 2007: still a nemesis

In recent years, the use of multidetector computed tomography (MDCT) for the diagnosis of acute thoracic injury in blunt trauma has expanded. MDCT has shown high accuracy for the diagnosis or exclusion of injury to the aorta and its primary branches, decreasing the need for thoracic angiography and allowing earlier treatment of this often rapidly fatal lesion. With increasing use of MDCT, more subtle injuries and variants of vascular anatomy are being recognized that create pitfalls in the diagnosis. Of perhaps more concern is the recognition that aortic injury can occur with little or no associated mediastinal hematoma, the principle chest radiographic finding indicating a need for further imaging. The importance of recognizing unusual sites of aortic injury, congenital variants of mediastinal anatomy, the precise extent of injury, and the anatomic pathology present as key factors in deciding among treatment options is emphasized.     

腹主动脉、髂动脉及下肢动脉的MR数字减影血管造影

目的探讨增强ＭＲ血管造影的方法,评价快速梯度回波序列增强ＭＲ数字减影血管造影对腹主动脉、髂动脉及下肢动脉病变的诊断价值。方法３６例临床疑有腹主动脉、髂动脉或下肢动脉疾病的病人进行增强３Ｄ快速梯度回波扫描（重复时间１２或２０毫秒、回波时间４或５毫秒、反转角６０°）。对比剂用量０．２ｍｍｏｌ／ｋｇ。原始图像先进行减影处理,再进行最大信号强度投影（ＭＩＰ）重建。结果所有３６例患者（包括６例正常）均满意地显示了感兴趣区的血管。其中,腹主动脉夹层动脉瘤４例,肾动脉狭窄２例,人工血管移植术３例,腹主动脉瘤２例,髂动静脉瘘１例,髂动脉及下肢动脉狭窄１８例。结论三维磁共振数字减影血管造影是腹部及外周血管成像可靠的、充满活力的方法。     

地震挤压伤致下肢横纹肌溶解症的MRI表现

目的 分析地震挤压伤致下肢横纹肌溶解症的MRI表现及临床应用价值.方法 回顾性分析5.12汶川大地震中临床确诊为地震挤压伤致双下肢横纹肌溶解症的3例患者双下肢MR平扫、增强、短时间反转恢复(STIR)序列和MR血管成像(MRA)征象,评价MR检查在挤压伤所致横纹肌溶解症临床诊治中的作用.结果 3例患者受压肢体MRI表现为皮下脂肪及筋膜肿胀、肌束紊乱、肌间隙模糊或可见局限性积液;受损肌肉在T2WI呈片状混杂高信号影,在T1WI呈等信号或稍低信号影,其内间杂有不均匀稍高信号影;STIR序列成像呈高信号影.增强可见不规则强化;在MRA,3例患者下肢主要动脉均未见明显狭窄及闭塞征象.结论 MRI能及时显示地震挤压伤受累肌肉范围、程度及相应的血管受累情况,可为其临床的及时诊断及治疗评估提供有利信息.     

早期外固定术在重型颅脑创伤合并四肢骨折中的应用

目的 探讨早期(<48 h)骨折外固定术在重型颅脑创伤(GCS≤8)合并四肢骨折患者中的临床应用效果.方法 统计重型颅脑创伤合并四肢骨折年龄、性别、颅脑创伤情况、骨折部位分布及其他全身情况等差异均无统计学意义的患者,根据骨折的早期(＜48 h)治疗方法不同,将重型颅脑创伤患者分为两组.A组:早期骨折外固定组(40例);B组:早期骨牵引、石膏固定等保守治疗组(57例).对比分析两组患者褥疮、肺炎、下肢静脉血栓形成等并发症发生情况,ICU时间、住院时间、骨折愈合时间、病死率等指标.结果 A组在感染率、褥疮、肺炎、下肢静脉血栓发生率方面明显低于B组(P＜0.05).A组的ICU时间、住院时间、骨折愈合时间短于B组(P＜0.05).A组的病死率低于B组,差异有统计学意义(P＜0.05).结论 针对重型颅脑创伤合并四肢骨折的患者,开展早期骨折外固定法与原有早期骨牵引、石膏固定等保守治疗方法相比,减少了并发症,缩短了恢复时间,降低了病死率.     

The place of angiography in the evaluation of traumatic injuries to the heart and coronary arteries

The mechanisms leading to traumatic injuries of the heart and coronary arteries and the typical lesions found are analyzed in light of experience with a total of 21 cases from several centers. The indications for angiography are discussed. Early angiography may be used for the emergency verification of a valvular, coronary, or myocardial rupture after intensive treatment has stabilized the patient's condition; in such situations the relative indications for angiography versus immediate surgery must be determined. Delayed angiography may be used in the more usual situations in which clear, persistent anomalies of a clinical, electric, or radiologic nature are observed.     

酗酒后腹部闭合性损伤的早期诊治体会

分析112例酗酒后腹部损伤患者的临床资料.早期确定性诊断和及时处理是降低死亡率的关键,维持生命体征、合理应用辅助检查、及时手术是提高抢救成功率的主要环节.     

Comprehensive MR angiography of the lower limbs: a hybrid dual-bolus approach including the pedal arteries

The purpose of this study was to include the pedal vasculature into the coverage of peripheral multistation magnetic resonance angiography (3DceMRA). A total of 216 patients suffering from peripheral vascular disease were examined with a modified hybrid dual-bolus technique. The cruropedal arteries were acquired first with two sagittal slabs and time-resolved 3D sequences. Then the aortofemoral vessels were visualized using the bolus-chase technique and a second contrast injection. Interventional procedures were performed in 104 patients, and in 69 of those, the cruropedal vessels were also examined with digital subtraction angiography (iaDSA). Using 3DceMRA, the cruropedal arteries were displayed with both excellent and good quality in 95% (205/216 cases), and without any venous overlay in 94% (203/216 cases). The aortofemoral vessels were not jeopardized by the first contrast injection. With iaDSA as the standard of reference, observed sensitivity of 3DceMRA was found in ranges from 80% (29%, 99%) to 100% (86%, 100%) for assessing significant stenoses, and observed specificity ranged between 93% [80%, 98%] and 100% (82%, 100%). In conclusion, hybrid dual-bolus 3DceMRA significantly reduces the limitations of standard single-bolus 3DceMRA in anatomic coverage and temporal resolution of the cruropedal arteries, thus providing high-quality images of the entire peripheral vasculature.     

钝性肾损伤肾切除因素分析

目的 探讨钝性肾损伤时影响肾切除的高危因素，以提高肾挽救率。方法 回顾性分析我院自1992年1月至2002年7月收治的226例严重钝性肾损伤患者的临床资料。结果 226例钝性肾损伤患者，保守治疗153例，手术治疗73例。其中肾切除术27例，术前平均输血633ml，平均损伤严重度评分(ISS)39．6分，入院时平均收缩压(SBP)85．4mmHg(1mmHg=0．133kPa)；肾部分切除术12例，术前平均输血487ml，平均ISS27．8分，入院时平均SBP99．7mmHg；肾修补术34例，术前平均输血262ml，平均ISS23．6分，入院时平均SBP112．3mmHg。结论 钝性肾损伤的严重程度与血尿的发生不相一致，切肾与延误治疗、肾损伤程度、术前输血量、ISS分值、入院时平均SBP和病理肾有关联。