Cruz Sebastian A, Castillo Hector, Chintapalli Ravi Theja V, Adams Olufemi E, Morgan Vince K, Koh Jason L, Lee Michael J, Shi Lewis L
University of Chicago Pritzker School of Medicine, Chicago, IL.
Operative Performance Research Institute, University of Chicago Medicine, Chicago, IL.
J Orthop Trauma. 2020 Aug;34(8):e261-e265. doi: 10.1097/BOT.0000000000001760.
To investigate the clinical utility of additional axillary or Velpeau views in evaluating potential shoulder trauma after a standard radiograph series of anteroposterior, Grashey, and/or trans-scapular views.
Retrospective study.
Level I academic medical center.
All patients in a 10-year span who received an initial shoulder radiograph series followed by additional axillary/Velpeau views within 24 hours.
The clinical utility of the additional axillary/Velpeau views, including the final diagnosis and treatment plan, as ascertained through examination of radiology reports, progress notes, and radiograph images.
A total of 271 cases were reviewed, with 35 patients being excluded from the final cohort because they received post-treatment radiographs to confirm a successful therapeutic outcome. The additional axillary/Velpeau views did not affect clinical decision making in 230 (97.5%) of the remaining 236 cases. All 6 patients whose care benefitted from the additional views carried the diagnosis of shoulder instability, accounting for 40% of this diagnostic group. The additional views confirmed an equivocal finding in 5 of these 6 cases and changed the diagnosis (demonstrating a posterior dislocation that was not evident on initial radiographs) and treatment plan (leading to a closed glenohumeral reduction procedure) in the other case.
Additional axillary/Velpeau views of suspected shoulder trauma rarely led to a change in the final treatment plan, except in patients in which a definitive diagnosis of stability or instability could not be made based on initial radiographs. A cost/benefit analysis is required to weigh the cost of additional radiographs with the benefit of capturing infrequent yet serious dislocations (usually posterior).
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
探讨在标准的前后位、Grashey位和/或经肩胛位X线片系列检查后，额外的腋位或Velpeau位X线片在评估潜在肩部创伤中的临床应用价值。
回顾性研究。
一级学术医疗中心。
10年间所有接受了初始肩部X线片系列检查，随后在24小时内接受了额外腋位/Velpeau位X线片检查的患者。
通过检查放射学报告、病程记录和X线片图像确定额外腋位/Velpeau位X线片的临床应用价值，包括最终诊断和治疗方案。
共审查了271例病例，35例患者因接受治疗后X线片以确认治疗成功而被排除在最终队列之外。在其余236例病例中，230例（97.5%）额外的腋位/Velpeau位X线片未影响临床决策。受益于额外X线片检查的所有6例患者均诊断为肩部不稳定，占该诊断组的40%。额外的X线片在这6例中的5例中证实了一个模棱两可的发现，在另一例中改变了诊断（显示出初始X线片上不明显的后脱位）和治疗方案（导致闭合性肱盂复位手术）。
怀疑肩部创伤时，额外的腋位/Velpeau位X线片很少导致最终治疗方案的改变，除非根据初始X线片无法明确诊断为稳定或不稳定的患者。需要进行成本效益分析，以权衡额外X线片的成本与捕捉罕见但严重脱位（通常为后脱位）的益处。
诊断性IV级。有关证据水平的完整描述，请参阅作者指南。
