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使用普通腕部X线片检测月骨周围腕骨骨折和脱位的诊断失败率。

Diagnostic Failure Rate in Detecting Perilunate Carpal Fractures and Dislocations Using Plain Wrist X-Rays.

作者信息

Tanure Aleixo Abreu, de Andrade Fernanda Ruiz, Rezende Luis Guilherme Rosifini Alves, Cagnolati Amanda Favaro, Mandarano-Filho Luiz Garcia, Mazzer Nilton

机构信息

Programa de Cirurgia da Mão, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HC-FMRP-USP), Ribeirão Preto, SP, Brasil.

Divisão de Cirurgia da Mão, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HC-FMRP-USP), Ribeirão Preto, SP, Brasil.

出版信息

Rev Bras Ortop (Sao Paulo). 2021 Jun;56(3):340-345. doi: 10.1055/s-0040-1714227. Epub 2020 Sep 25.

DOI:10.1055/s-0040-1714227
PMID:34239199
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8249065/
Abstract

The present study aimed to evaluate the diagnostic failure rate in detecting perilunate fractures and dislocations using plain wrist radiographs by orthopedists and orthopedic residents. A secondary objective was to identify possible groups with a greater or lesser chance of establishing a correct diagnosis.  An online questionnaire was sent to several orthopedists through e-mail, social networks, and smartphone-based communication applications to assess the rate of diagnostic failure in detecting perilunate fractures and dislocations using plain radiographs.  A total of 511 responses was obtained, with a diagnostic error rate of 8.81% for simple dislocations and 1.76% for trans-scaphoid perilunate fractures. Group stratification showed that residents presented the highest error rates in simple perilunate dislocations (23.91%), whereas hand surgeons presented the lowest error rates (1.74%).  Compared with the literature, the failure rates found were lower, suggesting that plain radiography is effective and that the error rate may not be as high as reported.

摘要

本研究旨在评估骨科医生和骨科住院医师使用腕部X线平片检测月骨周围骨折和脱位时的诊断失败率。次要目标是确定诊断正确可能性较大或较小的可能群体。

通过电子邮件、社交网络和基于智能手机的通信应用程序向多位骨科医生发送了一份在线问卷，以评估使用X线平片检测月骨周围骨折和脱位时的诊断失败率。

共获得511份回复，单纯脱位的诊断错误率为8.81%，经舟骨月骨周围骨折的诊断错误率为1.76%。分组分层显示，住院医师在单纯月骨周围脱位中的错误率最高（23.91%），而手外科医生中的错误率最低（1.74%）。

与文献相比，所发现的失败率较低，这表明X线平片是有效的，且错误率可能不像报道的那么高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b14/8249065/3cda350c85e4/10-1055-s-0040-1714227-i2000028pt-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b14/8249065/616604ddb4f1/10-1055-s-0040-1714227-i2000028en-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b14/8249065/87560b07c3da/10-1055-s-0040-1714227-i2000028en-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b14/8249065/100246e02f1f/10-1055-s-0040-1714227-i2000028en-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b14/8249065/f1e6e78216e7/10-1055-s-0040-1714227-i2000028pt-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b14/8249065/72cbfc482ff1/10-1055-s-0040-1714227-i2000028pt-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b14/8249065/3cda350c85e4/10-1055-s-0040-1714227-i2000028pt-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b14/8249065/616604ddb4f1/10-1055-s-0040-1714227-i2000028en-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b14/8249065/87560b07c3da/10-1055-s-0040-1714227-i2000028en-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b14/8249065/100246e02f1f/10-1055-s-0040-1714227-i2000028en-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b14/8249065/f1e6e78216e7/10-1055-s-0040-1714227-i2000028pt-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b14/8249065/72cbfc482ff1/10-1055-s-0040-1714227-i2000028pt-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b14/8249065/3cda350c85e4/10-1055-s-0040-1714227-i2000028pt-3.jpg

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本文引用的文献

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Perilunate Dislocations and Perilunate Fracture Dislocations in the U.S. Military.美国军队中的月骨周围脱位和月骨周围骨折脱位
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Perilunate fracture-dislocations: clinical and radiological results of 21 cases.月骨周围骨折脱位：21例的临床及影像学结果
Arch Orthop Trauma Surg. 2018 Feb;138(2):287-297. doi: 10.1007/s00402-017-2861-1. Epub 2017 Dec 27.
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Lack of experience is a significant factor in the missed diagnosis of perilunate fracture dislocation or isolated dislocation.
经验不足是月骨周围骨折脱位或单纯脱位漏诊的一个重要因素。
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Perilunate Injuries.月骨周围损伤
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[CONSIDERATIONS ON THE BLOODLESS REDUCTION OF A CASE OF PERILUNAR LUXATION OF THE CARPUS WITH FRACTURE OF THE SCAPHOID AND OF THE STYLOID APOPHYSIS OF THE RADIUS].
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Perilunar dislocation of the carpus. A diagnosis still often missed.
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