AIM: To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography(MDCT) in suspected scaphoid fractures.METHODS: One hundred twenty-four consecutive patient...AIM: To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography(MDCT) in suspected scaphoid fractures.METHODS: One hundred twenty-four consecutive patients were enrolled in our study who had suffered from a wrist trauma and showed typical clinical symptoms suspicious of an acute scaphoid fracture. All patients had initially undergone conventional radiography. Subsequent MDCT was performed within 10 d because of persisting clinical symptoms. Using the MDCT data as the reference standard, a fourfold table was used to classify the test results. The effective dose and impaired energy were assessed in order to compare the radiation burden of the two techniques. The Wilcoxon test was performed to compare the two diagnostic modalities.RESULTS: Conventional radiography showed 34 acute fractures of the scaphoid in 124 patients(42.2%). Subsequent MDCT revealed a total of 42 scaphoid fractures. The sensitivity of conventional radiography for scaphoid fracture detection was 42.8% and its specificity was 80% resulting in an overall accuracy of 59.6%. Conventional radiography was significantly inferior to MDCT(P < 0.01) concerning scaphoidfracture detection. The mean effective dose of MDCT was 0.1 m Sv compared to 0.002 m Sv of conventional radiography.CONCLUSION: Conventional radiography is insufficient for accurate scaphoid fracture detection. Regarding the almost negligible effective dose, MDCT should serve as the first imaging modality in wrist trauma.展开更多
Background: While plain radiography is commonly used to assess scaphoid fracture, this imaging modality may not accurately demonstrate early bone healing. This investigation evaluates the utility of 64-slice CT in the...Background: While plain radiography is commonly used to assess scaphoid fracture, this imaging modality may not accurately demonstrate early bone healing. This investigation evaluates the utility of 64-slice CT in the detection of early fracture healing compared to plain radiographs and magnetic resonance imaging (MRI). Methods: Outpatients attending follow-up visits for scaphoid fractures at Hamilton General Hospital were included in this investigation. Inclusion criteria included outpatients over age of 18 who consented to attend a follow-up visit for the scaphoid fracture at 6 weeks for X-Ray, 64-slice CT and MRI scan to monitor fracture healing. Assessment of healing was independently interpreted by two radiologists specialized in musculoskeletal imaging. A total of 7 adult outpatients were accrued, with each case classified as healing, not healing, or equivocal for plain radiography and 64-slice CT scan. Results: For plain radiographs, the level of interrater agreement for evidence of healing was 57% (4/7) cases. When comparing this to CT scans, there was no discrepancy between radiologists as 100% (7/7) were found to have evidence of healing. The 64-slice CT scan demonstrated evidence of early trabecular continuity in all cases, including radiographs that were interpreted as equivocal. Conclusion: This study can be considered a pilot project for the efficacy of 64-slice CT in the assessment of early healing of scaphoid fractures. For clinicians, the multiplanar reconstruction images allows for more accurate assessment of fractures than plain radiography. CT scans are able to penetrate through bony callus that may obscure visualization of healing in plain radiography, demonstrate trabecular continuity better than plain radiographs, are readily accessible and provide faster imaging acquisition. The observations from this study may have implications in terms of duration and type of casting applied, timing of strengthening exercises, and avoiding unnecessary surgery which affect patient morbidity and cost of ca展开更多
目的研究记忆合金弓齿钉内固定联合复元活血汤治疗新鲜腕舟状骨骨折患者的疗效及对腕关节功能的影响。方法采用前瞻性研究,以医院2018年1月—2020年4月诊断并治疗的新鲜腕舟状骨骨折患者120例作为研究对象,采用信封法,将以上患者随机分...目的研究记忆合金弓齿钉内固定联合复元活血汤治疗新鲜腕舟状骨骨折患者的疗效及对腕关节功能的影响。方法采用前瞻性研究,以医院2018年1月—2020年4月诊断并治疗的新鲜腕舟状骨骨折患者120例作为研究对象,采用信封法,将以上患者随机分为观察组及对照组,每组60例,两组患者均采取记忆合金弓齿钉内固定治疗,观察组患者在此基础上联合采用复元活血汤进行治疗。比较两组患者的治疗效果、疼痛情况、腕关节功能、上肢功能评定量表(disabilities ofarm,shoulder and hand,DASH)评分以及不良反应之间的差异。结果观察组患者的治疗优良率(91.67%,55/60)显著高于对照组(78.33%,47/60),差异存在统计学意义(χ^(2)=4.182,P=0.041);治疗后,两组患者的视觉模拟评分法(visual analog scale,VAS)评分均显著降低,且观察组患者3 d、7 d VAS评分显著低于对照组(t=6.925,P=0.000;t=4.243,P=0.000),治疗4周后,观察组患者掌屈(t=30.828,P=0.000)、背伸(t=4.697,P=0.000)、桡偏(t=3.811,P=0.000)、尺偏(t=2.782,P=0.000)的活动范围显著高于对照组,观察组患者的DASH评分A部分(t=5.597,P=0.000)、B部分(t=9.193,P=0.000)、总分(t=5.176,P=0.000)均显著低于对照组,两组患者发生骨不连、伤口感染以及骨坏死情况之间的差异不存在统计学意义(P>0.05)。结论记忆合金弓齿钉内固定联合复元活血汤治疗新鲜腕舟状骨骨折,患者的腕关节功能恢复显著,疼痛情况下降,治疗效果显著。展开更多
文摘AIM: To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography(MDCT) in suspected scaphoid fractures.METHODS: One hundred twenty-four consecutive patients were enrolled in our study who had suffered from a wrist trauma and showed typical clinical symptoms suspicious of an acute scaphoid fracture. All patients had initially undergone conventional radiography. Subsequent MDCT was performed within 10 d because of persisting clinical symptoms. Using the MDCT data as the reference standard, a fourfold table was used to classify the test results. The effective dose and impaired energy were assessed in order to compare the radiation burden of the two techniques. The Wilcoxon test was performed to compare the two diagnostic modalities.RESULTS: Conventional radiography showed 34 acute fractures of the scaphoid in 124 patients(42.2%). Subsequent MDCT revealed a total of 42 scaphoid fractures. The sensitivity of conventional radiography for scaphoid fracture detection was 42.8% and its specificity was 80% resulting in an overall accuracy of 59.6%. Conventional radiography was significantly inferior to MDCT(P < 0.01) concerning scaphoidfracture detection. The mean effective dose of MDCT was 0.1 m Sv compared to 0.002 m Sv of conventional radiography.CONCLUSION: Conventional radiography is insufficient for accurate scaphoid fracture detection. Regarding the almost negligible effective dose, MDCT should serve as the first imaging modality in wrist trauma.
文摘Background: While plain radiography is commonly used to assess scaphoid fracture, this imaging modality may not accurately demonstrate early bone healing. This investigation evaluates the utility of 64-slice CT in the detection of early fracture healing compared to plain radiographs and magnetic resonance imaging (MRI). Methods: Outpatients attending follow-up visits for scaphoid fractures at Hamilton General Hospital were included in this investigation. Inclusion criteria included outpatients over age of 18 who consented to attend a follow-up visit for the scaphoid fracture at 6 weeks for X-Ray, 64-slice CT and MRI scan to monitor fracture healing. Assessment of healing was independently interpreted by two radiologists specialized in musculoskeletal imaging. A total of 7 adult outpatients were accrued, with each case classified as healing, not healing, or equivocal for plain radiography and 64-slice CT scan. Results: For plain radiographs, the level of interrater agreement for evidence of healing was 57% (4/7) cases. When comparing this to CT scans, there was no discrepancy between radiologists as 100% (7/7) were found to have evidence of healing. The 64-slice CT scan demonstrated evidence of early trabecular continuity in all cases, including radiographs that were interpreted as equivocal. Conclusion: This study can be considered a pilot project for the efficacy of 64-slice CT in the assessment of early healing of scaphoid fractures. For clinicians, the multiplanar reconstruction images allows for more accurate assessment of fractures than plain radiography. CT scans are able to penetrate through bony callus that may obscure visualization of healing in plain radiography, demonstrate trabecular continuity better than plain radiographs, are readily accessible and provide faster imaging acquisition. The observations from this study may have implications in terms of duration and type of casting applied, timing of strengthening exercises, and avoiding unnecessary surgery which affect patient morbidity and cost of ca
文摘目的研究记忆合金弓齿钉内固定联合复元活血汤治疗新鲜腕舟状骨骨折患者的疗效及对腕关节功能的影响。方法采用前瞻性研究,以医院2018年1月—2020年4月诊断并治疗的新鲜腕舟状骨骨折患者120例作为研究对象,采用信封法,将以上患者随机分为观察组及对照组,每组60例,两组患者均采取记忆合金弓齿钉内固定治疗,观察组患者在此基础上联合采用复元活血汤进行治疗。比较两组患者的治疗效果、疼痛情况、腕关节功能、上肢功能评定量表(disabilities ofarm,shoulder and hand,DASH)评分以及不良反应之间的差异。结果观察组患者的治疗优良率(91.67%,55/60)显著高于对照组(78.33%,47/60),差异存在统计学意义(χ^(2)=4.182,P=0.041);治疗后,两组患者的视觉模拟评分法(visual analog scale,VAS)评分均显著降低,且观察组患者3 d、7 d VAS评分显著低于对照组(t=6.925,P=0.000;t=4.243,P=0.000),治疗4周后,观察组患者掌屈(t=30.828,P=0.000)、背伸(t=4.697,P=0.000)、桡偏(t=3.811,P=0.000)、尺偏(t=2.782,P=0.000)的活动范围显著高于对照组,观察组患者的DASH评分A部分(t=5.597,P=0.000)、B部分(t=9.193,P=0.000)、总分(t=5.176,P=0.000)均显著低于对照组,两组患者发生骨不连、伤口感染以及骨坏死情况之间的差异不存在统计学意义(P>0.05)。结论记忆合金弓齿钉内固定联合复元活血汤治疗新鲜腕舟状骨骨折,患者的腕关节功能恢复显著,疼痛情况下降,治疗效果显著。
