Murphy Joseph T, Hall Jason, Provost David
University of Texas Southwestern Medical Center, Department of Surgery, Division of Burns, Trauma, Critical Care, Dallas, 75390, USA.
J Trauma. 2005 Oct;59(4):843-6. doi: 10.1097/01.ta.0000187382.28199.2d.
Local stab wound (SW) exploration to assess abdominal fascial integrity is a highly invasive procedure frequently performed under demanding circumstances in the Emergency Department (ED). We hypothesized ultrasound (U/S) may be useful in the detection of fascial defects resulting from anterior abdominal stab injury, eliminating the need for local wound exploration
Thirty-five hemodynamically normal patients evaluated at a Level I trauma center for anterior abdominal stab wounds were examined by U/S (8 mHz probe) for evidence of fascial violation. All patients were subsequently evaluated by local wound exploration
Fascial U/S had an overall sensitivity of 59% and specificity of 100%, (PPV 100%, NPV 59%) for detection of fascial SW defects compared with local wound exploration. The sensitivity of fascial U/S for stab wound evaluation varied directly with experience of the sonographer
A positive fascial U/S obviates the need for invasive SW exploration; however, a negative fascial U/S does not preclude the need for local wound exploration. Resident U/S training for specific penetrating injuries may reduce the need for abdominal SW fascial exploration in the ED.
局部刺伤探查以评估腹部筋膜完整性是一种高度侵入性的操作，常在急诊科的苛刻情况下进行。我们推测超声（U/S）可能有助于检测腹部前侧刺伤导致的筋膜缺损，从而无需进行局部伤口探查。
在一级创伤中心对35例血流动力学正常的腹部前侧刺伤患者进行超声（8兆赫兹探头）检查，以寻找筋膜受损的证据。随后所有患者均接受局部伤口探查。
与局部伤口探查相比，筋膜超声检测筋膜刺伤缺损的总体敏感性为59%，特异性为100%（阳性预测值100%，阴性预测值59%）。筋膜超声评估刺伤伤口的敏感性与超声检查者的经验直接相关。
筋膜超声检查结果为阳性可避免进行侵入性刺伤探查；然而，筋膜超声检查结果为阴性并不能排除进行局部伤口探查的必要性。对住院医师进行针对特定穿透伤的超声培训可能会减少急诊科腹部刺伤筋膜探查的需求。
