Seagger R, Bunker T, Hamer P
Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK.
Ann R Coll Surg Engl. 2011 Oct;93(7):528-31. doi: 10.1308/147870811X13137608454939.
Nearly 1 in 40 of the population seeks medical advice related to a shoulder problem every year. The majority pertain to rotator cuff pathology. Prior to intervention in such patients it is imperative to define whether the tendons are intact or torn. Ultrasonography has become an essential adjunct to clinical assessment in diagnosing rotator cuff tears. This study was designed to investigate if a surgeon using a portable ultrasonography machine in a one-stop shoulder clinic could significantly reduce the time a patient waited from initial outpatient presentation to the end of the treatment episode (be it surgery, injection or conservative management).
A total of 77 patients were allocated to one of two groups: Group A, consisting of 37 patients who were assessed and had ultrasonography as outpatients, and Group B, consisting of 40 patients who were assessed and referred for departmental ultrasonography where appropriate. Three clear outcome groups were defined: those who required surgical repair, those who had irreparable tears and those who declined surgery.
For all outcomes (surgery, irreparable tears and conservative treatment), the patients in Group A all completed their clinical episodes significantly quicker than those in Group B (p<0.02). As well as the time saving benefits, there was a substantial financial saving for Group A. By performing ultrasonography in the outpatients department, those patients avoided the requirement of departmental imaging (£120) and subsequent follow-up appointments (£73) to discuss results and management, resulting in a saving of nearly £200 per patient.
The use of a portable ultrasonography machine by an orthopaedic surgeon can significantly reduce the time to treatment and the financial cost for patients with rotator cuff tears.
每年有近四十分之一的人口因肩部问题寻求医疗建议。其中大多数与肩袖病变有关。在对这类患者进行干预之前，必须确定肌腱是否完整或撕裂。超声检查已成为诊断肩袖撕裂临床评估的重要辅助手段。本研究旨在调查在一站式肩部诊所使用便携式超声检查仪的外科医生是否能显著缩短患者从首次门诊就诊到治疗结束（无论是手术、注射还是保守治疗）的等待时间。
总共77名患者被分配到两组中的一组：A组，由37名作为门诊患者接受评估并进行超声检查的患者组成；B组，由40名接受评估并在适当情况下被转诊至科室进行超声检查的患者组成。明确界定了三个清晰的结果组：需要手术修复的患者、肩袖撕裂无法修复的患者以及拒绝手术的患者。
对于所有结果（手术、不可修复的撕裂和保守治疗），A组患者完成临床治疗的时间均明显短于B组患者（p<0.02）。除了节省时间外，A组还节省了大量费用。通过在门诊进行超声检查，这些患者避免了科室影像学检查（120英镑）以及随后讨论检查结果和治疗方案的后续预约（73英镑），每位患者节省了近200英镑。
骨科医生使用便携式超声检查仪可显著缩短肩袖撕裂患者的治疗时间并降低其经济成本。
