Orlinsky Michael, Bright Aaron A
Department of Emergency Medicine, LAC+USC Medical Center, University of Southern California Keck School of Medicine, Los Angeles, 90033, USA.
Am J Emerg Med. 2006 Mar;24(2):233-6. doi: 10.1016/j.ajem.2005.06.008.
It is a common practice to routinely obtain x-rays before clinical evaluation and cleaning of glass-caused wounds to assess for possible retained foreign bodies (FBs). [Am J Surg 1982;144(July):63-5; Ann Emerg Med 1983;12(July):434-7; Emerg Med Clin NorthAm 1985;3(2):383-91; Emerg Med Clin North Am 1992;10:163-77; Ann Emerg Med 1988 17(12):125-34; Emerg Med Clin North Am 1992;10(4):757-79] This prospective study was designed to question whether routine x-rays are necessary for all patients with glass-caused wounds. Plain films were taken before clinical exam but not reviewed until after the exam was completed. Wounds were categorized according to depth, whether or not the clinician was able to adequately explore the wound, and whether or not an FB was found clinically. Glass FBs were found in 23 (8.7%) of 264 wounds. Approximately half of the wounds were no deeper than subcutaneous fat. Almost all of these superficial wounds (99.2%, 133/134) could be adequately explored. There were clinically undetected FBs (ie, wounds that benefited from x-ray) in 2 (1.5%) of 134 superficial wounds and 10 (7.7%) of 130 deeper wounds. In light of the benign nature of the 2 superficial wounds in which an FB was missed clinically, we conclude that there exists a subset of glass-caused wounds that are superficial and adequately explorable, and, therefore, do not need routine x-rays.
在对玻璃所致伤口进行临床评估和清创之前常规进行X线检查以评估是否可能存在异物残留，这是一种常见的做法。[《美国外科杂志》1982年；144(7月)：63 - 5；《急诊医学杂志》1983年；12(7月)：434 - 7；《北美急诊医学临床》1985年；3(2)：383 - 91；《北美急诊医学临床》1992年；10：163 - 77；《急诊医学杂志》1988年17(12)：125 - 34；《北美急诊医学临床》1992年；10(4)：757 - 79] 这项前瞻性研究旨在质疑对于所有玻璃所致伤口的患者常规进行X线检查是否必要。在临床检查前拍摄平片，但直到检查完成后才进行阅片。根据伤口深度、临床医生是否能够充分探查伤口以及临床上是否发现异物对伤口进行分类。在264处伤口中有23处(8.7%)发现了玻璃异物。大约一半的伤口不超过皮下脂肪层。几乎所有这些浅表伤口(99.2%，133/134)都能够得到充分探查。在134处浅表伤口中有2处(1.5%)以及130处较深伤口中有10处(7.7%)存在临床上未检测到的异物(即从X线检查中受益的伤口)。鉴于2处临床上漏诊异物的浅表伤口的良性性质，我们得出结论，存在一部分浅表且能够充分探查的玻璃所致伤口，因此不需要常规进行X线检查。
