Mehta M, Brautigan M W
Department of Emergency Medicine, Mount Carmel Mercy Hospital, Detroit, Michigan.
Ann Emerg Med. 1990 Mar;19(3):255-7. doi: 10.1016/s0196-0644(05)82039-6.
A prospective study was conducted to determine the usefulness of clinical findings and 25-degree pronation and supination radiologic views to diagnose carpal navicular fractures. All patients presenting to the emergency department during a two-year period who fell on their outstretched hand and had pain and/or swelling in the anatomic snuffbox were evaluated initially and at two weeks. All patients received at least the standard four-view wrist radiography. If a fracture was not detected, two additional views were obtained. Ninety patients were enrolled; 54 fractures of the navicular were evident on initial four-view radiography. Thirty-six patients with a negative initial four-view radiograph had two additional views; 11 of the 36 were found to have a fracture. The other 25 patients failed to show fracture. In this series; no fractures were missed when six-view radiography was used. Anatomic snuffbox tenderness was 100% sensitive and 76% specific and had a 92% positive predictive value for carpal navicular fracture. We conclude that patients clinically suspected of carpal navicular fracture should undergo additional radiologic views if the standard four views of the wrist are negative.
进行了一项前瞻性研究，以确定临床检查结果以及腕关节25度旋前和旋后位X线片对诊断腕舟骨骨折的作用。在两年期间，所有因伸直手摔倒且解剖学鼻烟窝处有疼痛和/或肿胀而到急诊科就诊的患者在初始时和两周时均接受了评估。所有患者至少接受了标准的腕关节四视图X线摄影。如果未检测到骨折，则再拍摄另外两张视图。共纳入90例患者；54例舟骨骨折在初始四视图X线片上清晰可见。36例初始四视图X线片阴性的患者又拍摄了另外两张视图；这36例中有11例被发现有骨折。另外25例患者未显示骨折。在本系列中，使用六视图X线摄影时没有漏诊骨折。解剖学鼻烟窝压痛对腕舟骨骨折的敏感性为100%，特异性为76%，阳性预测值为92%。我们得出结论，如果腕关节的标准四视图为阴性，临床上怀疑腕舟骨骨折的患者应接受额外的X线视图检查。
