- 期刊
替代式腕關節側位X光攝影照法之效性評估
The Feasibility of Alternative Wrist Lateral Projection Radiography
摘要
本研究目地為探討由Steward AL所提出之替代式腕關節側位X光攝影之效性。本研究通過人體試驗審查委員會，執行期間為西元2020年1月至西元2020年12月。收案條件為年齡20歲以上之受檢者，於高雄市立小港醫院接受腕關節X光攝影檢查，經說明後同意參加此研究且能配合擺位者。受檢者共收案61位，每位受檢者均接受一張腕關節後前位（PA view）及兩張腕關節側位（lateral view）影像。在側位攝影擺位時，其中一張以傳統式擺位方法；另一張以替代式擺位方法執行。我們藉由疼痛量表來評估每位患者在配合兩種側位擺位時，所產生疼痛程度之差異。獲得的影像經隨機排列後，分別由兩位有經驗的影像醫學科醫師，對橈腕關節（radiocarpal joint）處側位影像之品質進行評分，並對每位患者的影像進行骨折的診斷。疼痛程度及影像品質之分數，以SPSS（Statistical Product and Service Solutions）軟體進行成對樣本T檢定（paired sample t test）分析，對骨折之診斷率以敏感度、特異性及準確度分析評估。結果發現，替代式擺位對患者造成之疼痛感，明顯小於傳統式擺位（1.85±2.23vs2.80±2.67, p＜0.001），而在橈腕關節處，替代式側位之影像品質也明顯優於傳統式側位（2.75±0.39vs2.00±0.30, p＜0.001）。對於骨折之診斷率方面，兩種側位擺位影像在合併後前位擺位之影像下，均能提供非常好的診斷率（醫師A/B對骨折之診斷率，在傳統擺位及替代擺位，其敏感度、特異性、準確度分別為-傳統擺位： 100%/95.65%、100%/100%、100%/98.36%；替代擺位：：95.65%/95.65%、100%/100%、98.36%/98.36%）。依據本研究的結果顯示，替代式腕關節側位X光攝影可減少患者的疼痛感，帶來更好的橈腕關節處影像品質，且對腕部骨折提供良好的診斷率，可考慮應用於日常腕關節攝影執行之中。
並列摘要
The purpose of this study is to evaluate the feasibility of the alternative wrist lateral projection radiography proposed by Steward AL. This study was approved by the Institutional Review Board (IRB) in our institution. We collected patients older than 20 years old with wrist radiography in our hospital, from January 2020 to December 2020. A total of 61 patients were collected. All of them had sign informed consent before this study. In addition to one wrist posteroanterior (PA) projection, every patient also accepted two wrist lateral projection - one by the conventional lateral position and the other by alternative wrist lateral position respectively. We record the patients' experience of pain during the examination by pain scale. These images were distributed to two experienced radiologists separately, to make a score for image quality of the radiocarpal joint lateral view. The diagnosis for fracture of each patient was also made. The statistics were collected and analyzed by SPSS (Statistical Product and Service Solutions) with paired samples t-test. The result revealed that in the alternative wrist lateral projection radiography, patients had lower sensation of pain (1.85±2.23 vs 2.80±2.67, p<0.001 ). The image quality of the radiocarpal joint in alternative lateral position was also better in comparison to the conventional one (2.75±0.39 vs 2.00±0.30, p<0.001). In both alternative and conventional lateral projection in combination with PA projection, can provide similar excellent diagnostic rate for fracture (The sensitivity, specificity and accuracy of diagnosis for fracture in doctor A/B in conventional and alternative position are: 100%/95.65%, 100%/100%, 100%/98.36% and 5.65%/95.65%, 100%/100%, 98.36%/98.36% respectively). In conclusion, by using the alternative wrist lateral projection radiography can reduce patient's experience of pain, provide better image quality of radiocarpal joint, and provide excellent diagnostic rate for wrist fracture.