四肢血管损伤的彩色多普勒超声诊断及误诊漏诊原因分析

The color Doppler ultrasound diagnosis for blood vessel injury of extremity and analysis of misdiagnosis and missed diagnosis

目的研究彩色多普勒超声在四肢血管损伤诊断中的应用价值及误诊漏诊原因。方法选取76例高度怀疑四肢血管损伤的患者,彩色多普勒超声重点观察四肢血管走行、管壁连续性、血流方向及连续性、管腔通畅程度。脉冲多普勒(PW)测量四肢血管血流流速(Vmax)、收缩期峰值流速(Vmax)、频谱形态、阻力指数(RI),并与数字减影血管造影(DSA)或手术探查结果对比。结果 76例患者中有60例动脉损伤,包括15例部分动脉胁迫征,13例完全动脉胁迫征,4例动脉管壁部分断裂,9例管壁完全断裂,11例动脉内膜挫伤并血栓形成,5例管壁部分破裂合并假性动脉瘤和3例管壁部分破裂合并动静脉瘘。5例合并静脉损伤全部漏诊。血流中断型动脉损伤中,远端动脉出现侧支循环供血,其特点为双向、低速、低阻、呈小慢波或低阻型动脉样频谱。彩色多普勒超声诊断血管损伤的结果与DSA或手术探查结果对比,准确性为72.3%。结论彩色多普勒超声对于四肢血管损伤诊断具有较高的准确性,可作为四肢血管损伤的首选影像学检查手段。

Objective To study the application of color Doppler ultrasound （CDU） on blood vessel injury of extremity , the reasons of misdiagnosis and missed diagnosis. Methods A total of 77 cases with extremely suspected blood vessel injury were examined with CDU. The observation of the four limbs blood ves- sel continuity, unobstructed degree, flow rate（ Vmax）, spectrum form, resistance index（RI） were concentrat- ed by CDU. The results of examination were contrasted with those of DSA and operation. Results A total of 77 cases included 17 control cases and 60 cases of artery damage. In this 60 cases, 15 cases of artery incom- plete entrapment syndrome,13 cases of artery complete entrapment syndrome,4 cases of incomplete rupture, 9 cases of complete rupture, 11 cases of artery intima trauma and thrombosis ,5 eases of pseudoaneurysm and 3 cases of arteriovenous malformation were included. Five cases complicated with vein injury were misdiag- nosed. The haemodynamics of collateral circulation involved two-way, brachytely, slow wave and venous like Dopple wave. Compared the result with DSA or operation,the accuracy is 72.3%. Conclusion The diag- nosis of the four-limb blood vessel loss by CDU have high accuracy, and could be chosen as the method of the four-limb blood vessel loses examination.