پديد آورندگان :
فروتن، سيدكمال دانشگاه علوم پزشكي ايران - بيمارستان حضرت فاطمه - بخش جراحي ترميمي و پلاستيك - گروه جراحي ترميمي و پلاستيك , رحيميان، شهرام دانشگاه علوم پزشكي ايران - بيمارستان حضرت فاطمه - بخش جراحي ترميمي و پلاستيك - گروه جراحي ترميمي و پلاستيك , اكبري، حسين دانشگاه علوم پزشكي ايران - بيمارستان حضرت فاطمه - بخش جراحي ترميمي و پلاستيك - گروه جراحي ترميمي و پلاستيك , موسوي، جابر دانشگاه علوم پزشكي تهران - بيمارستان امام خميني (ره) - گروه طب پيشگيري و پزشكي اجتماعي، , حسني، اسماعيل دانشگاه علوم پزشكي ايران - بيمارستان حضرت فاطمه - بخش جراحي ترميمي و پلاستيك - گروه جراحي ترميمي و پلاستيك
كليدواژه :
ارزش اخباري مثبت , ارزش اخباري منفي , گانگرن , ايسكمي , انگشتان
چكيده فارسي :
ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺁﺯﻣﻮﻥ ﻫﺎﻱ ﺗﺸﺨﻴﺼﻲ ﺩﺭ ﺍﻧﺘﺨﺎﺏ ﺩﺭﻣﺎﻥ ﻣﻨﺎﺳﺐ ﺟﻬﺖ ﺁﺳﻴﺐ ﻫﺎﻱ ﻟﻪ ﺷﺪﮔﻲ ﺍﻧﮕﺸﺘﺎﻥ ﻭ ﭘﻴﺶ ﺑﻴﻨﻲ ﺍﺣﺘﻤﺎﻝ ﺍﻳﺠﺎﺩ ﮔﺎﻧﮕﺮﻥ ﺩﺭﺁﻧﻬﺎ ﺍﺯ ﺍﻫﻤﻴﺖ ﺑﺎﻻﻳﻲ ﺑﺮﺧﻮﺭﺩﺍﺭﻧﺪ. ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﺗﻌﻴﻴﻦ ﻭ ﻣﻘﺎﻳﺴﻪ ﺷﺎﺧﺺ ﻫﺎﻱ ﺣﺴﺎﺳﻴﺖ، ﻭﻳﮋﮔﻲ، ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ ﻣﺜﺒﺖ ])[Positive Predictive Value (PPV ﻭ ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ ﻣﻨﻔﻲ [Negative Predictive Value (NPV)] ﺷﺶ ﺁﺯﻣﻮﻥ ﺷﺎﻳﻊ ﺗﺸﺨﻴﺺ ﺍﻳﺴﮑﻤﻲ ﺭﻧﮓ ﺍﻧﮕﺸﺘﺎﻥ، ﺁﺯﻣﻮﻥ ﭘﺮ ﺷﺪﻥ ﻣﺠﺪﺩ ﻣﻮﻳﺮﮔﻲ، ﺣﺮﺍﺭﺕ،
ﺗﺴﺖ ﺧﻮﻧﺮﻳﺰﻱ ﺑﺎ ﺳﻮﺯﻥ ﺷﻤﺎﺭﻩ 23، ﺩﺍﭘﻠﺮ ﻭ ﭘﺎﻟﺲ ﺍﮐﺴﻴﻤﺘﺮﻱ( ﺩﺭ ﭘﻴﺶ ﺑﻴﻨﻲ ﺍﺣﺘﻤﺎﻝ ﺍﻳﺠﺎﺩ ﮔﺎﻧﮕﺮﻥ ﺩﺭ ﺍﻧﮕﺸﺘﺎﻥ ﻟﻪ ﺷﺪﻩ ﻣﻲ ﭘﺮﺩﺍﺯﺩ.
ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮ ﺭﻭﻱ 144 ﺍﻧﮕﺸﺖ ﻟﻪ ﺷﺪﻩ ﮐﻪ ﺩﺭ ﺑﺪﻭ ﻣﺮﺍﺟﻌﻪ ﺑﺮ ﺍﺳﺎﺱ ﺭﻧﮓ، ﺣﺮﺍﺭﺕ ﻭ ﭘﺮ ﺷﺪﻥ ﻣﻮﻳﺮﮔﻲ ﺍﻳﺴﮑﻤﻴﮏ ﺗﺸﺨﻴﺺ ﺩﺍﺩﻩ ﺷﺪﻩ ﻭ ﺑﺎﺯﺳﺎﺯﻱ ﻋﺮﻭﻗﻲ ﺍﻣﮑﺎﻥ ﭘﺬﻳﺮ ﻧﺒﻮﺩﻩ ﺍﺳﺖ، ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺍﺳﺖ. ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﺗﺤﺖ ﺩﺭﻣﺎﻥ ﮐﻨﺴﺮﻭﺍﺗﻴﻮ ﺑﻪ ﺻﻮﺭﺕ ﺩﺑﺮﻳﺪﻣﺎﻥ ﺟﺰﺋﻲ، ﺟﺎﺍﻧﺪﺍﺯﻱ ﺷﮑﺴﺘﮕﻲ ﻫﺎ، ﺗﺮﻣﻴﻢ ﭘﻮﺳﺖ ﻭ ﺑﻲ ﺣﺮﮐﺘﻲ ﺩﺭ ﺍﺳﭙﻠﻴﻨﺖ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﻭ 6 ﺭﻭﺵ ﺗﺸﺨﻴﺺ ﺍﻳﺴﮑﻤﻲ ﺷﺎﻣﻞ ﺭﻧﮓ ﺍﻧﮕﺸﺘﺎﻥ، ﺣﺮﺍﺭﺕ ﺍﻧﮕﺸﺘﺎﻥ ،ﻣﺪﺕ ﺯﻣﺎﻥ ﭘﺮ ﺷﺪﻥ ﻣﺠﺪﺩ ﻣﻮﻳﺮﮔﻲ، ﺗﺴﺖ ﺧﻮﻧﺮﻳﺰﻱ ﺑﺎ ﺳﻮﺯﻥ ﺷﻤﺎﺭﻩ 23، ﺩﺍﭘﻠﺮ ﻭ ﭘﺎﻟﺲ ﺍﮐﺴﻴﻤﺘﺮﻱ ﺩﺭ ﭘﻴﺶ ﺑﻴﻨﻲ ﺍﺣﺘﻤﺎﻝ ﺍﻳﺠﺎﺩ ﮔﺎﻧﮕﺮﻥ ﺩﺭ ﺍﻧﮕﺸﺘﺎﻥ ﻟﻪ ﺷﺪﻩ ﺑﺮ ﺍﺳﺎﺱ ﺷﺎﺧﺺ ﻫﺎﻱ ﺣﺴﺎﺳﻴﺖ، ﻭﻳﮋﮔﻲ، ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ ﻣﺜﺒﺖ
ﻭ ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ ﻣﻨﻔﻲ ﺑﺮﺭﺳﻲ ﺷﺪﻩ ﺍﺳﺖ.
ﻳﺎﻓﺘﻪ ﻫﺎ: 4 ﺁﺯﻣﻮﻥ ﺭﻧﮓ ﺍﻧﮕﺸﺘﺎﻥ، ﻣﺪﺕ ﺯﻣﺎﻥ ﭘﺮ ﺷﺪﻥ ﻣﺠﺪﺩ ﻣﻮﻳﺮﮔﻲ، ﺩﺍﭘﻠﺮ ﻭ ﭘﺎﻟﺲ ﺍﮐﺴﻴﻤﺘﺮﻱ،ﺑﻴﺸﺘﺮﻳﻦ ﺣﺴﺎﺳﻴﺖ ﺭﺍ ﺩﺍﺭﻧﺪ ﻭ ﮐﻤﺘﺮﻳﻦ ﺣﺴﺎﺳﻴﺖ ﻣﺮﺑﻮﻁ ﺑﻪ ﺁﺯﻣﻮﻥ ﺧﻮﻧﺮﻳﺰﻱ ﺑﺎ ﺳﻮﺯﻥ ﺍﺳﺖ 68/75 ﺑﻴﺸﺘﺮﻳﻦ ﻭﻳﮋﮔﻲ ﻣﺮﺑﻮﻁ ﺑﻪ ﺁﺯﻣﻮﻥ ﺧﻮﻧﺮﻳﺰﻱ ﻣﻲ ﺑﺎﺷﺪ ﺁﺯﻣﻮﻥ ﻫﺎﻱ ﺭﻧﮓ ﻭ ﺣﺮﺍﺭﺕ ﮐﻤﺘﺮﻳﻦ ﻭﻳﮋﮔﻲ )17/8 ﻭ ﺁﺯﻣﻮﻥ ﺣﺮﺍﺭﺕ ﮐﻤﺘﺮﻳﻦ ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ ﻣﺜﺒﺖ )24/59 ﺭﺍ ﺩﺍﺭﻧﺪ، ﺩﺭﺣﺎﻟﻴﮑﻪ ﺁﺯﻣﻮﻥ ﺧﻮﻧﺮﻳﺰﻱ ﺑﺎ ﺳﻮﺯﻥ ﺷﻤﺎﺭﻩ 23 ﺑﻴﺸﺘﺮﻳﻦ ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ ﻣﺜﺒﺖ ﺭﺍ ﺑﻪ ﺧﻮﺩ ﺍﺧﺘﺼﺎﺹ ﺩﺍﺩﻩ ﺍﺳﺖ ﺑﻴﺸﺘﺮﻳﻦ ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ ﻣﻨﻔﻲ ﺩﺭ ﻣﻮﺭﺩ ﺁﺯﻣﻮﻥ ﻫﺎﻱ ﺭﻧﮓ ﺍﻧﮕﺸﺘﺎﻥ ،ﻣﺪﺕ ﺯﻣﺎﻥ ﭘﺮ ﺷﺪﻥ ﻣﺠﺪﺩ ﻣﻮﻳﺮﮔﻲ، ﺩﺍﭘﻠﺮ ﻭ ﭘﺎﻟﺲ
ﺍﮐﺴﻴﻤﺘﺮﻱ ﻣﻲ ﺑﺎﺷﺪ )100%(، ﺩﺭﺣﺎﻟﻴﮑﻪ ﺩﺭ ﻣﻮﺭﺩ ﺁﺯﻣﻮﻥ ﺣﺮﺍﺭﺕ ﺍﺯ ﺑﻘﻴﻪ ﮐﻤﺘﺮ ﺍﺳﺖ 90%(.
ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺁﺯﻣﻮﻥ ﻫﺎﻱ ﺭﻧﮓ ﺍﻧﮕﺸﺘﺎﻥ، ﻣﺪﺕ ﺯﻣﺎﻥ ﭘﺮ ﺷﺪﻥ ﻣﺠﺪﺩ ﻣﻮﻳﺮﮔﻲ، ﺩﺍﭘﻠﺮ ﻭ ﭘﺎﻟﺲ ﺍﮐﺴﻴﻤﺘﺮﻱ ﺑﻪ ﻋﻠﺖ ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ ﻣﻨﻔﻲ 100 ﺩﺭ ﺻﻮﺭﺕ ﻧﺮﻣﺎﻝ ﺑﻮﺩﻥ ﺑﺴﻴﺎﺭ ﺍﺭﺯﺷﻤﻨﺪﻧﺪ، ﺩﺭﺣﺎﻟﻴﮑﻪ ﺁﺯﻣﻮﻥ ﺧﻮﻧﺮﻳﺰﻱ ﺑﺎ ﺳﻮﺯﻥ ﺷﻤﺎﺭﻩ 23 ﺑﻪ ﻋﻠﺖ ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ ﻣﺜﺒﺖ 100 ﺩﺭ ﺻﻮﺭﺕ ﻏﻴﺮﻃﺒﻴﻌﻲ ﺑﻮﺩﻥ ﺑﺴﻴﺎﺭ ﺍﺭﺯﺷﻤﻨﺪ ﺍﺳﺖ. ﺁﺯﻣﻮﻥ ﺣﺮﺍﺭﺕ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺍﻳﻨﮑﻪ ﻧﻪ ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ ﻣﺜﺒﺖ ﻭ ﻧﻪ ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ ﻣﻨﻔﻲ ﺁﻥ ﻣﺎﻧﻨﺪ ﺗﺴﺖ ﻫﺎﻱ ﻗﺒﻠﻲ ﺑﺎﻻ ﻧﻴﺴﺖ، ﭼﻨﺪﺍﻥ ﺩﺭ ﻧﺘﻴﺠﻪ ﮔﻴﺮﻱ ﻫﺎ ﻗﺎﺑﻞ ﺍﺳﺘﻔﺎﺩﻩ ﻧﻴﺴﺖ.
چكيده لاتين :
Introduction & Objective: Diagnostic tests are important in treatment planning and prediction of the
probability of gangrene in hand crushing injuries. This study determines and compares sensitivity, specificity,
Positive Predictive Value and Negative Predictive Value of six common diagnostic tests of ischemia in
prediction of probability of gangrene.
Materials & Methods: The study has been performed on 144 crushed fingers that at presentation based
on color, temperature and capillary refill were ischemic and vascular reconstruction was impossible.
Conservative treatment including minimal debridment, fracture reduction, skin closure and immobilization in
splint was done and sensitivity, specificity, Positive Predictive Value, Negative Predictive Value of diagnostic
tests including: color, temperature, capillary refill, pinprick with gauge needle number 23, handheld Doppler
and pulse oximetry in prediction of probability of gangrene was evaluated.
Results: Color, capillary refill, Doppler and pulse oximetry have the greatest sensitivity (100%) and
pinprick with needle has the least sensitivity (68.75%). In contrast, pinprick test has the greatest specificity
(100%) and color and temperature have the least ones (17.8%). Pinprick test has the greatest Positive
Predictive Value (100%), and, color capillary refill, pulse oximetry and Doppler have the greatest negative
Predictive Value (100%). Negative Predictive Value for temperature is the least one (90%).
Conclusions: Color, capillary refill, pulse oximetry and Doppler because of Negative Predictive Value
equal to100% are invaluable, when they are normal. In contrast, pinprick with gauge needle number 23
because of Positive Predictive Value equal to 100% is invaluable when it is normal. Temperature, because of
inconclusive Negative Predictive Value and Positive Predictive Value is not very helpful in treatment
planning.
