背景:点护理超声(PoCUS)是一种安全的,用于识别桡骨远端骨折的非侵入性工具,可用于帮助临床医生减少移位骨折。我们旨在测试PoCUS是否准确识别桡骨远端骨折,并确定PoCUS作为确认骨折复位成功的工具的表现。
方法:对出现前臂损伤导致Colle’s型桡骨远端骨折的成年患者进行了一项务实的前瞻性观察性研究。从2018年8月至2019年7月到急诊科(ED)就诊的疑似前臂远端骨折的成年人可以方便地取样,以便在有训练有素的ED超声医师的情况下纳入研究。在X射线之前,使用高频线性换能器(7.5-10mHz)对最大压痛点进行PoCUS扫描。在订购第二张X射线之前,需要对骨折进行操作的患者在手术后立即进行了第二次超声扫描。比较两组的PoCUS扫描与X射线的准确性。
结果:使用PoCUS和X线两种方式在47例患者中发现了骨折。这显示出100%的灵敏度(95%CI:90-100%)和100%的特异性(95%CI:31-100%)。44例患者中有35例需要骨折操作。与X射线相比,PoCUS在确定对准准确性方面的敏感性和特异性分别为100%(95%CI:83-100%)和64%(95%CI:32-88%)。PPV和NPV分别为86%(95%CI:66-95%)和100%(95%CI:56-100%)。44例桡骨远端骨折患者中有10例(23%)最终需要切开复位内固定(ORIF)。
结论:我们的研究支持使用PoCUS识别前臂桡骨远端骨折,并可能在帮助临床医生确定复位后的成功方面具有一定价值。我们仍然主张使用标准的X射线照片来确认操作后成功或充分的皮质对齐。
BACKGROUND: Point of Care Ultrasound (PoCUS) is a safe, non-invasive tool for identifying distal radius fractures and can potentially be utilised to assist clinicians to reduce displaced fractures. We aim to test whether PoCUS is accurate to identify distal radius fractures and to determine how PoCUS performs as a tool to confirm a successful fracture reduction.
METHODS: A pragmatic prospective observational
study was done in adult patients presenting with forearm injuries resulting in Colle\'s type distal radius fractures. Adults who presented to the emergency department (ED) with a suspected distal forearm fracture from August 2018 to July 2019 were conveniently sampled for inclusion into the
study when a trained ED ultra-sonographer was available. PoCUS scans over the point of maximal tenderness were done using a high frequency linear transducer (7.5-10 mHz) prior to X-ray. Patients who required a manipulation of the fracture had a second ultrasound scan immediately after the procedure before the second X-ray was ordered. PoCUS scans were compared to X-rays for accuracy in both groups.
RESULTS: Fractures were identified in 44 out of 47 included patients using both PoCUS and X-ray modalities. This showed a sensitivity of 100% (95% CI: 90-100%) and specificity of 100% (95% CI: 31-100%). Fracture manipulation was required in 35 out of 44 patients. The sensitivity and specificity of PoCUS in determining alignment accuracy when compared to X-ray were 100% (95% CI: 83-100%) and 64% (95% CI: 32-88%) respectively. The PPV and NPV were 86% (95% CI: 66-95%) and 100% (95% CI: 56-100%) respectively. Ten out of 44 (23%) patients with distal radius fractures ultimately required an Open Reduction and Internal Fixation (ORIF).
CONCLUSIONS: Our
study supports the use of PoCUS for identifying distal radius forearm fractures and may have some value in assisting clinicians to determine post reduction success. We still advocate using standard X-ray radiographs to confirm successful or adequate cortical alignment following a manipulation.