急诊室床旁超声对隐匿性桡骨头骨折的早期诊断：一项CT对比诊断研究
Bedside Ultrasonography for Early Diagnosis of Occult Radial Head Fractures in Emergency Room: A CT-Comparative Diagnostic Study.
作者信息
Malahias Michael-Alexander, Manolopoulos Philip-Panagiotis, Kadu Vikram, Shahpari Omid, Fagkrezos Dimitrios, Kaseta Maria-Kyriaki
机构信息
Research performed at Orthopaedic Department, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
Orthopaedic Department, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
出版信息
Arch Bone Jt Surg. 2018 Nov;6(6):539-546.
BACKGROUND
Some of the Mason type I fractures cannot be detected on early radiographic images. These occult fractures are considered as a diagnostic challenge for physicians. Our aim was to determine the value of bedside ultrasonography for the detection of Mason I radial head fractures that are non-visible in early X-ray's.
METHODS
A prospective blind single-center diagnostic study was conducted (from June 2012 till May 2013) concerning 23 patients who were clinically suspicious of having a radial head fracture. These patients were evaluated with a bedside high frequency ultrasound in the Emergency Room (E.R.). The two sonographic criteria that were considered to be diagnostic for fracture were: a. effusion besides the radial head-neck and b. cortical discontinuity of the radial head or neck. All patients also underwent a Computed Tomography (CT) as the gold standard imaging modality for diagnosis of occult radial head fractures.
RESULTS
Fifteen out of 23 patients were diagnosed with radial head fracture using both ultrasound and CT. On the other hand, there were three patients with negative ultrasound and positive CT, in addition two patients were found positive in the ultrasonographic exam, while this result was not confirmed by the CT scan. In comparison with CT, ultrasound exam appeared to have 83.3% sensitivity, 60% specificity, 88.2% positive prognostic value and 50% negative prognostic value (when at least one diagnostic sonographic criterion was positive). The accuracy of the sonographic study for the diagnosis of the aforementioned fractures was 78.2%. Effusion in contact with the radial neck was the most sensitive sonographic sign (14/15 of the true positive radial head ultrasounds).
CONCLUSION
Bedside ultrasound in the E.R. was proven to be a sensitive tool for early (day-1) diagnosis of the occult radial head fractures. It could be used as an adjacent imaging modality in patients suspicious for radial head fracture, when the initial X-rays are negative.
LEVEL OF EVIDENCE
II.
背景
部分梅森I型骨折在早期X线影像上无法检测到。这些隐匿性骨折对医生来说是一项诊断挑战。我们的目的是确定床边超声检查对检测早期X线片上不可见的梅森I型桡骨头骨折的价值。
方法
进行了一项前瞻性单中心盲法诊断研究（2012年6月至2013年5月），涉及23例临床怀疑有桡骨头骨折的患者。这些患者在急诊室接受了床边高频超声检查。被认为可诊断骨折的两个超声标准为：a.桡骨头颈部旁有积液；b.桡骨头或颈部皮质连续性中断。所有患者还接受了计算机断层扫描（CT），作为诊断隐匿性桡骨头骨折的金标准成像方式。
结果
23例患者中，15例经超声和CT诊断为桡骨头骨折。另一方面，有3例超声检查阴性但CT检查阳性，另外有2例超声检查阳性，但CT扫描未证实该结果。与CT相比，超声检查的敏感性为83.3%，特异性为60%，阳性预测值为88.2%，阴性预测值为50%（当至少一项诊断性超声标准为阳性时）。超声检查对上述骨折诊断的准确性为78.2%。与桡骨颈接触的积液是最敏感的超声征象（15例真正阳性的桡骨头超声检查中有14例出现该征象）。
结论
急诊室的床边超声被证明是早期（第1天）诊断隐匿性桡骨头骨折的敏感工具。当最初的X线检查为阴性时，它可作为怀疑桡骨头骨折患者的辅助成像方式。
证据级别
II级。
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