Blankstein A, Cohen I, Heiman Z, Salai M, Diamant L, Heim M, Chechick A
Department of Orthopedic Surgery, Sheba Medical Center, Tel-Hashomer, Israel.
Isr Med Assoc J. 2001 Jun;3(6):411-3.
Foreign bodies are sometimes overlooked in the initial evaluation of soft tissue wounds in the emergency room setting. The physical examination identifies foreign bodies that are superficial enough to be seen or palpated, while radiographs reveal those that are radio-opaque. If these two criteria are not met, however, the foreign body may remain undetected. These patients present later with long-standing pain in the area of penetration sometimes associated with localized tenderness.
To assess the role of ultrasonography in the diagnosis and management of patients with a suspected retained foreign body.
Ultrasound was used in 21 patients with suspected retained foreign bodies and the diagnosis was positive in 19. Fifteen underwent a surgical exploration in which the ultrasound was used as an adjunctive modality either pre- or intraoperatively to assist in the localization of the foreign body.
All procedures were successful. No postoperative complications were recorded at an average follow-up of 2 years. Three patients gradually became asymptomatic and were left untreated. One patient was lost to follow-up.
Sonography is an extremely effective tool for the late diagnosis of retained foreign bodies in the soft tissues. We suggest that its availability in the emergency room may decrease the rate of misdiagnosis and avoid these unfortunate cases, although this remains to be proven.
在急诊室对软组织伤口进行初步评估时，异物有时会被忽视。体格检查可发现位置表浅、能够看到或摸到的异物，而X光片则能显示不透射线的异物。然而，如果这两个标准都不满足，异物可能仍无法被检测到。这些患者随后会出现穿透部位长期疼痛，有时伴有局部压痛。
评估超声检查在疑似有异物残留患者的诊断和治疗中的作用。
对21例疑似有异物残留的患者使用了超声检查，其中19例诊断为阳性。15例患者接受了手术探查，术中或术前将超声作为辅助手段以协助定位异物。
所有手术均成功。平均随访2年，未记录到术后并发症。3例患者逐渐无症状，未接受治疗。1例患者失访。
超声检查是软组织中异物残留晚期诊断的极其有效的工具。我们认为，尽管这一点尚有待证实，但在急诊室配备超声检查可能会降低误诊率，避免这些不幸情况的发生。
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