使用床边超声评估住院医师对足踝解剖结构的触诊技能
Evaluation of Resident Palpation Skills in Foot and Ankle Anatomic Structures Using Bedside Ultrasound.
作者信息
Lee Se Won, Le Phuong U, Van Dien Craig, Hansen Mike, Tiu Timothy
机构信息
MountainView Hospital.
Lehigh Valley Health Nework.
出版信息
HCA Healthc J Med. 2020 Jun 27;1(3):161-167. doi: 10.36518/2689-0216.1029. eCollection 2020.
OBJECTIVE
The objective is to determine the accuracy of foot and ankle joint and soft tissue structure palpation in Physical Medicine and Rehabilitation (PM&R) residents using ultrasonography (US) verification.
METHODS
PM&R residents were tested in an outpatient musculoskeletal (MSK) clinic on palpated foot and ankle anatomic structures in a human model. Once the presumed structures were localized, residents marked a 1 cm size circle on the overlying skin with a ink marker. The accuracy of the circle over the joint line and soft tissue structures was verified using US.
RESULTS
The overall palpation accuracy for 22 joint line and soft tissue structures was 38.0%. Accuracy by foot and ankle region, including the posterior, medial, lateral, plantar, and dorsal were 72.9%, 47.5%, 42.5%, 35% and 7.8% respectively. There was a positive trend with level of education without a statistically significant difference in palpation accuracy (30.4% in PGY-2, 38.3% in PGY-3, 44.2% in PGY-4, p = 0.11).
CONCLUSIONS
Residents in this study demonstrated suboptimal accuracy of foot and ankle anatomic structure identification by palpation. US may be a useful adjunctive tool to advance current methods of teaching musculoskeletal examination skills to PM&R residents.
目的
目的是通过超声（US）验证来确定物理医学与康复（PM&R）住院医师对足踝关节及软组织结构触诊的准确性。
方法
在门诊肌肉骨骼（MSK）诊所，让PM&R住院医师在人体模型上对足踝关节的解剖结构进行触诊测试。一旦确定了推测的结构，住院医师用墨水笔在覆盖的皮肤上标记一个1厘米大小的圆圈。使用超声验证圆圈在关节线和软组织结构上的准确性。
结果
22个关节线和软组织结构的总体触诊准确率为38.0%。足踝关节各区域的准确率，包括后侧、内侧、外侧、足底和背侧，分别为72.9%、47.5%、42.5%、35%和7.8%。教育水平呈正相关趋势，但触诊准确率无统计学显著差异（PGY-2为30.4%，PGY-3为38.3%，PGY-4为44.2%，p = 0.11）。
结论
本研究中的住院医师在通过触诊识别足踝关节解剖结构方面表现出欠佳的准确性。超声可能是一种有用的辅助工具，可改进目前向PM&R住院医师教授肌肉骨骼检查技能的方法。
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