Finkenberg J G, Hoffer E, Kelly C, Zinar D M
Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Md.
J Hand Surg Am. 1993 Jan;18(1):4-7. doi: 10.1016/0363-5023(93)90236-V.
We investigated a new means of diagnosing occult scaphoid fractures. Eighty-six patients underwent vibratory testing at presentation, while the clinical examination and standard four-view x-ray examination findings were unknown to the persons who performed the vibratory testing of both the injured and uninjured wrists. Thirty-six patients had radiographically confirmed scaphoid fractures and, after their vibratory tests, were eliminated from the study. Fifty patients, 39 men and 11 women, were believed to have scaphoid fractures on the basis of history and clinical examination findings but were included in the occult scaphoid study group because standard four-view x-ray films of the wrists did not reveal a scaphoid fracture. Distinction between the fracture and no-fracture patients was made with a limited two-phase technetium bone scan and delayed x-ray examination. All patients with known scaphoid fractures (36) had positive findings on vibratory examination. Vibratory testing identified all six of the patients with occult scaphoid fractures (sensitivity 100%). Results of two examinations were false-positive, and none were false-negative (specificity 95%). One of the patients with false-positive results had a fracture of the trapezium, and the other had reflex sympathetic dystrophy. The vibratory testing of injured wrists is inexpensive, noninvasive, and easy to perform, and it involves no ionizing radiation.
我们研究了一种诊断隐匿性舟状骨骨折的新方法。86例患者在就诊时接受了振动测试，而进行受伤和未受伤手腕振动测试的人员并不知晓临床检查和标准四视图X线检查结果。36例患者经X线检查确诊为舟状骨骨折，在进行振动测试后被排除在研究之外。50例患者（39名男性和11名女性）根据病史和临床检查结果被认为可能存在舟状骨骨折，但因手腕标准四视图X线片未显示舟状骨骨折而被纳入隐匿性舟状骨研究组。通过有限的两阶段锝骨扫描和延迟X线检查来区分骨折患者和无骨折患者。所有已知舟状骨骨折的患者（36例）振动检查结果均为阳性。振动测试识别出了所有6例隐匿性舟状骨骨折患者（敏感性为100%）。两项检查结果中有两例假阳性，无假阴性（特异性为95%）。其中一例假阳性结果患者为大多角骨骨折，另一例为反射性交感神经营养不良。受伤手腕的振动测试价格低廉、无创且易于操作，并且不涉及电离辐射。
