即时超声引导下与标准复位治疗急诊中移位性桡骨远端骨折的比较：一项随机对照临床试验。

Point-of-care ultrasound-guided versus standard reduction of displaced distal radius fractures in the emergency department: a randomised controlled clinical trial.

机构信息

Department of Emergency Medicine, Isala, Zwolle, The Netherlands

Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.

出版信息

Emerg Med J. 2023 Nov 28;40(12):826-831. doi: 10.1136/emermed-2023-213178.

DOI:10.1136/emermed-2023-213178

PMID:37748865

Abstract

BACKGROUND

During closed reduction of displaced distal radius fractures, physical examination is used to determine the need for further manipulation before radiographic confirmation and cast application. Manipulation performed under ultrasound guidance has the potential to decrease the number of reduction attempts.

METHODS

This multicentre randomised controlled trial was undertaken between December 2018 and July 2020 in the ED of four hospitals in the Netherlands. Patients aged ≥16 years presenting to the ED with a distal radius fracture requiring closed reduction were randomised to either point-of-care ultrasound (PoCUS)-guided or standard reduction. The primary outcome was the proportion of patients requiring more than one reduction attempt. The secondary outcomes were time to complete reduction and treatment plan at ED discharge (conservative or operative repair).

RESULTS

A total of 214 patients were screened, of which 211 patients were included for primary endpoint analysis (87% female, median age 68 years, 94% dorsal angulation, 59% intra-articular and 73% multifragmentary). In total, 105 patients were randomised to standard treatment and 106 patients to PoCUS-guided fracture reduction. In the standard treatment group, 13 patients (12%) required more than one reduction attempt, compared with 6 patients (6%) in the PoCUS group (OR 2.35, 95% CI 0.86 to 6.45). The median reduction time was 5 min in the PoCUS group (IQR 3-6) vs 3 min (IQR 2-4) in the standard reduction group (p<0.001). At ED discharge, operative repair was indicated for 17 (16%) patients in the standard group and 21 (20%) patients in the PoCUS group (OR 0.78, 95% CI 0.39 to 1.58).

CONCLUSION

This study could not demonstrate that PoCUS-guided reduction of distal radius fractures was associated with a statistically significant decrease in the number of reduction attempts.

TRIAL REGISTRATION NUMBER

The Netherlands Trial Register (NTR7934).

摘要

背景

在闭合复位移位的桡骨远端骨折时，体格检查用于在进行放射确认和石膏固定之前确定是否需要进一步的手法复位。在超声引导下进行的复位操作有可能减少复位尝试的次数。

方法

这项多中心随机对照试验于 2018 年 12 月至 2020 年 7 月在荷兰四家医院的急诊部进行。将因需要闭合复位的桡骨远端骨折而到急诊部就诊的年龄≥16 岁的患者随机分为床边超声（POCUS）引导复位或标准复位组。主要结局是需要多次复位尝试的患者比例。次要结局是在急诊部出院时完成复位的时间和治疗计划（保守或手术修复）。

结果

共筛选了 214 名患者，其中 211 名患者被纳入主要终点分析（87%为女性，中位年龄 68 岁，94%为背侧成角，59%为关节内，73%为多骨折块）。共有 105 名患者被随机分配到标准治疗组，106 名患者被分配到 POCUS 引导复位组。在标准治疗组中，有 13 名患者（12%）需要多次复位尝试，而 POCUS 组中只有 6 名患者（6%）需要多次复位尝试（OR 2.35，95%CI 0.86 至 6.45）。POCUS 组的中位复位时间为 5 分钟（IQR 3-6），而标准复位组为 3 分钟（IQR 2-4）（p<0.001）。在急诊部出院时，标准组中有 17 名患者（16%）需要手术修复，而 POCUS 组中有 21 名患者（20%）需要手术修复（OR 0.78，95%CI 0.39 至 1.58）。