{"id":24078,"date":"2023-07-25T04:30:00","date_gmt":"2023-07-24T20:30:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=24078"},"modified":"2023-07-25T05:46:02","modified_gmt":"2023-07-24T21:46:02","slug":"nejm%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%84%bf%e7%ab%a5%e5%89%8d%e8%87%82%e8%bf%9c%e7%ab%af%e5%8f%af%e7%96%91%e9%aa%a8%e6%8a%98%e7%9a%84%e8%b6%85%e5%a3%b0%e6%88%96x%e5%85%89%e8%af%8a","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24078","title":{"rendered":"[NEJM\u53d1\u8868\u8bba\u6587]\uff1a\u5bf9\u513f\u7ae5\u524d\u81c2\u8fdc\u7aef\u7591\u4f3c\u9aa8\u6298\u5e94\u7528\u8d85\u58f0\u6216X\u5149\u68c0\u67e5\u8bca\u65ad"},"content":{"rendered":"\n

ORIGINAL ARTICLE<\/a><\/p>\n\n\n\n

Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures<\/h1>\n\n\n\n

Peter J. Snelling, Philip Jones, David Bade, et al<\/h3>\n\n\n\n

N Engl J Med 2023; 388:2049-2057
DOI: 10.1056\/NEJMoa2213883<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

BACKGROUND<\/h2>\n\n\n\n

Data on whether ultrasonography for the initial diagnostic imaging of forearm fractures in children and adolescents is noninferior to radiography for subsequent physical function of the arm are limited.<\/p>\n\n\n\n

\u80cc\u666f<\/strong><\/p>\n\n\n\n

\u4f5c\u4e3a\u513f\u7ae5\u548c\u9752\u5c11\u5e74\u524d\u81c2\u9aa8\u6298\u7684\u521d\u59cb\u5f71\u50cf\u5b66\u8bca\u65ad\u65b9\u6cd5\uff0c\u6709\u5173\u8d85\u58f0\u68c0\u67e5\u5728\u540e\u7eed\u624b\u81c2\u529f\u80fd\u65b9\u9762\u662f\u5426\u4e0d\u52a3\u4e8eX\u7ebf\u68c0\u67e5\u7684\u7814\u7a76\u6570\u636e\u6709\u9650\u3002<\/p>\n\n\n\n

METHODS<\/h2>\n\n\n\n

In this open-label, multicenter, noninferiority, randomized trial in Australia, we recruited participants 5 to 15 years of age who presented to the emergency department with an isolated distal forearm injury, without a clinically visible deformity, in whom further evaluation with imaging was indicated. Participants were randomly assigned to initially undergo point-of-care ultrasonography or radiography, and were then followed for 8 weeks. The primary outcome was physical function of the affected arm at 4 weeks as assessed with the use of the validated Pediatric Upper Extremity Short Patient-Reported Outcomes Measurement Information System (PROMIS) score (range, 8 to 40, with higher scores indicating better function); the noninferiority margin was 5 points.<\/p>\n\n\n\n

\u65b9\u6cd5<\/strong>\u5728\u6fb3\u5927\u5229\u4e9a\u5f00\u5c55\u7684\u8fd9\u9879\u5f00\u653e\u6807\u7b7e\u3001\u591a\u4e2d\u5fc3\u3001\u975e\u52a3\u6548\u6027\u3001\u968f\u673a\u8bd5\u9a8c\u4e2d\uff0c\u6211\u4eec\u7eb3\u5165\u4e86\u56e0\u5b64\u7acb\u6027\u524d\u81c2\u8fdc\u7aef\u635f\u4f24\u5230\u6025\u8bca\u79d1\u5c31\u8bca\uff0c\u65e0\u4e34\u5e8a\u53ef\u89c1\u53d8\u5f62\uff0c\u4e14\u9700\u8981\u8fdb\u4e00\u6b65\u5f71\u50cf\u5b66\u8bc4\u4f30\u76845~15\u5c81\u53c2\u4e0e\u8005\u3002\u53c2\u4e0e\u8005\u88ab\u968f\u673a\u5206\u7ec4\uff0c\u6700\u521d\u63a5\u53d7\u5e8a\u65c1\u8d85\u58f0\u68c0\u67e5\u6216X\u7ebf\u68c0\u67e5\uff0c\u7136\u540e\u63a5\u53d78\u5468\u968f\u8bbf\u3002\u4e3b\u8981\u7ed3\u5c40\u662f\u7b2c4\u5468\u65f6\uff0c\u4f7f\u7528\u7ecf\u8fc7\u9a8c\u8bc1\u7684\u513f\u7ae5\u4e0a\u80a2\u7b80\u6613\uff08Pediatric Upper Extremity Short\uff09\u60a3\u8005\u62a5\u544a\u7ed3\u5c40\u6d4b\u91cf\u4fe1\u606f\u7cfb\u7edf\uff08Patient-Reported Outcomes Measurement Information System\uff0cPROMIS\uff09\u8bc4\u5206\uff08\u8303\u56f4\uff0c8~40\uff0c\u8bc4\u5206\u8f83\u9ad8\u8868\u793a\u529f\u80fd\u8f83\u597d\uff09\u8bc4\u4f30\u60a3\u80a2\u751f\u7406\u529f\u80fd\uff1b\u975e\u52a3\u6548\u6027\u754c\u503c\u4e3a5\u5206\u3002<\/a><\/p>\n\n\n\n

RESULTS<\/h2>\n\n\n\n

A total of 270 participants were enrolled, with outcomes for 262 participants (97%) available at 4 weeks (with a window of \u00b13 days) as prespecified. PROMIS scores at 4 weeks in the ultrasonography group were noninferior to those in the radiography group (mean, 36.4 and 36.3 points, respectively; mean difference, 0.1 point; 95% confidence interval [CI], \u22121.3 to 1.4). Intention-to-treat analyses (in 266 participants with primary outcome data recorded at any time) produced similar results (mean difference, 0.1 point; 95% CI, \u22121.3 to 1.4). No clinically important fractures were missed, and there were no between-group differences in the occurrence of adverse events.<\/p>\n\n\n\n

\u7ed3\u679c<\/strong><\/p>\n\n\n\n

\u672c\u8bd5\u9a8c\u5171\u8ba1\u7eb3\u5165270\u4f8b\u53c2\u4e0e\u8005\uff0c\u5e76\u5728\u7b2c4\u5468\uff08\u00b13\u65e5\u65f6\u95f4\u7a97\uff09\u65f6\u83b7\u5f97\u4e86\u5176\u4e2d262\u4f8b\uff0897%\uff09\u7684\u9884\u8bbe\u7ed3\u5c40\u3002\u8d85\u58f0\u68c0\u67e5\u7ec4\u7b2c4\u5468\u65f6\u7684PROMIS\u8bc4\u5206\u4e0d\u52a3\u4e8eX\u7ebf\u68c0\u67e5\u7ec4\uff08\u5747\u503c\uff0c\u5206\u522b\u4e3a36.4\u5206\u548c36.3\u5206\uff1b\u5e73\u5747\u5dee\u5f02\uff0c0.1\u5206\uff1b95%\u7f6e\u4fe1\u533a\u95f4[CI]\uff0c\uff0d1.3~1.4\uff09\u3002\u610f\u5411\u6027\u6cbb\u7597\u5206\u6790\uff08\u5728\u4efb\u4e00\u65f6\u95f4\u8bb0\u5f55\u4e86\u4e3b\u8981\u7ed3\u5c40\u6570\u636e\u7684266\u4f8b\u53c2\u4e0e\u8005\u4e2d\uff09\u4ea7\u751f\u4e86\u76f8\u4f3c\u7ed3\u679c\uff08\u5e73\u5747\u5dee\u5f02\uff0c0.1\u5206\uff1b95% CI\uff0c\uff0d1.3~1.4\uff09\u3002\u672a\u53d1\u751f\u4e34\u5e8a\u91cd\u8981\u9aa8\u6298\u88ab\u6f0f\u8bca\u7684\u60c5\u51b5\uff0c\u4e0d\u826f\u4e8b\u4ef6\u53d1\u751f\u7387\u65e0\u7ec4\u95f4\u5dee\u5f02\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

CONCLUSIONS<\/h2>\n\n\n\n

In children and adolescents with a distal forearm injury, the use of ultrasonography as the initial diagnostic imaging method was noninferior to radiography with regard to the outcome of physical function of the arm at 4 weeks. (Funded by the Emergency Medicine Foundation and others; BUCKLED Australian New Zealand Clinical Trials Registry number,\u00a0ACTRN12620000637943. opens in new tab<\/a>).<\/p>\n\n\n\n

\u7ed3\u8bba<\/strong><\/p>\n\n\n\n

\u5728\u524d\u81c2\u8fdc\u7aef\u635f\u4f24\u7684\u513f\u7ae5\u548c\u9752\u5c11\u5e74\u4e2d\uff0c\u5728\u7b2c4\u5468\u65f6\u7684\u624b\u81c2\u751f\u7406\u529f\u80fd\u7ed3\u5c40\u65b9\u9762\uff0c\u4f5c\u4e3a\u521d\u59cb\u5f71\u50cf\u5b66\u8bca\u65ad\u65b9\u6cd5\uff0c\u8d85\u58f0\u68c0\u67e5\u4e0d\u52a3\u4e8eX\u7ebf\u68c0\u67e5\u3002\uff08\u7531\u6025\u8bca\u533b\u5b66\u57fa\u91d1\u4f1a[Emergency Medicine Foundation]\u7b49\u8d44\u52a9\uff1bBUCKLED\u6fb3\u5927\u5229\u4e9a\u65b0\u897f\u5170\u4e34\u5e8a\u8bd5\u9a8c\u6ce8\u518c\u53f7\u4e3aACTRN12620000637943\uff09\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"

ORIGINAL ARTICLE Ultrasonography or Radiography for Sus […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24078"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24078"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24078\/revisions"}],"predecessor-version":[{"id":24081,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24078\/revisions\/24081"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24078"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24078"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24078"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}