诊断肩关节脱位：是时候改变观念了。
Diagnosing shoulder dislocations: time for a change of view.
作者信息
Espag M P, Back D L, Baroni M, Bennett A R, Peckham T J
机构信息
Derbyshire Royal Infirmary, UK.
出版信息
Ann R Coll Surg Engl. 2002 Sep;84(5):334-7. doi: 10.1308/003588402760452466.
Posterior shoulder dislocations are uncommon, with frequent delays in the diagnosis. Three missed posterior dislocations within our hospital caused us to review the standard radiographs taken and the knowledge of this condition. A total of 40 radiographers and 40 casualty officers were surveyed. Of the radiographers, 63% felt it unnecessary to perform two views, they complained that laterals were difficult to obtain because of patient distress. All the radiographers surveyed knew of alternative views, but would not perform them unless specifically requested. Casualty officers claimed always to request two views, but did not in 75% of cases. Only 20% were aware of alternative views, all would accept one view for exclusion of a dislocation and none were aware of the radiographic signs associated with a posterior dislocation. Increased education and a change of view would assist in decreasing the rate of missed diagnoses.
肩关节后脱位并不常见，诊断常常延迟。我院发生的三例漏诊的肩关节后脱位促使我们重新审视所拍摄的标准X线片以及对这种情况的认识。我们共调查了40名放射技师和40名急诊室医生。在放射技师中，63%的人认为没有必要拍摄两个体位的片子，他们抱怨由于患者痛苦，很难获得侧位片。所有接受调查的放射技师都知道有其他体位的片子，但除非有特别要求，否则他们不会拍摄。急诊室医生声称总是要求拍摄两个体位的片子，但在75%的病例中并未这样做。只有20%的人知道有其他体位的片子，所有人都接受用一个体位的片子来排除脱位，而且没有人知道与后脱位相关的X线征象。加强教育和改变观念将有助于降低漏诊率。
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