{"id":2557,"date":"2024-03-07T08:03:03","date_gmt":"2024-03-06T23:03:03","guid":{"rendered":"https:\/\/www.hcfm.jp\/journal\/?p=2557"},"modified":"2024-03-07T08:03:03","modified_gmt":"2024-03-06T23:03:03","slug":"%e5%89%8d%e8%85%95%e9%81%a0%e4%bd%8d%e7%ab%af%e9%aa%a8%e6%8a%98%e3%81%8c%e7%96%91%e3%82%8f%e3%82%8c%e3%82%8b%e5%b0%8f%e5%85%90%e3%81%ab%e3%81%8a%e3%81%91%e3%82%8b%e3%83%9d%e3%82%a4%e3%83%b3%e3%83%88","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=2557","title":{"rendered":"\u524d\u8155\u9060\u4f4d\u7aef\u9aa8\u6298\u304c\u7591\u308f\u308c\u308b\u5c0f\u5150\u306b\u304a\u3051\u308b\u30dd\u30a4\u30f3\u30c8\u30aa\u30d6\u30b1\u30a2\u8d85\u97f3\u6ce2\u691c\u67fb\u3068X\u7dda\u691c\u67fb\u306e\u6bd4\u8f03"},"content":{"rendered":"

\u203b\u3053\u306e\u6642\u671f\u306eUpToDate\u306b\u3042\u308b\u201dWhat\u2019s new in family medicine\u201d\u306eTopic\u3067\u53c2\u8003\u306b\u3055\u308c\u3066\u3044\u308b\u6587\u732e\u3067\u3059\u3002
\n-\u6587\u732e\u540d-
\nP J.Snelling. Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures. NEJM. 2023; 388;22<\/p>\n

-\u8981\u7d04-
\nIntroduction
\n\u25cf\t\u5c0f\u5150\u306e\u9aa8\u6298\u3067\u591a\u3044\u306e\u304c\u82e5\u6728\u9aa8\u6298\u3067\u3042\u308a\u3001\u30ea\u30b9\u30c8\u30b9\u30d7\u30ea\u30f3\u30c8\u3084\u6574\u5fa9\u3001\u56fa\u5b9a\u8853\u7b49\u306e\u51e6\u7f6e\u304c\u884c\u308f\u308c\u308b
\n\u25cf\tXp\u691c\u67fb\u304c\u30eb\u30fc\u30c1\u30f3\u3067\u884c\u308f\u308c\u308b\u304c\u3001\u898b\u843d\u3068\u3057\u3082\u591a\u304f\u3001\u307e\u305f\u3001\u9014\u4e0a\u56fd\u3067\u306f\u5229\u7528\u3067\u304d\u306a\u3044\u3053\u3068\u3082\u591a\u3044
\n\u25cf\t\u305d\u3093\u306a\u4e2d\u3067\u9aa8\u6298\u306b\u5bfe\u3059\u308bPoint-of-care \u30a8\u30b3\u30fc(POCUS)\u306e\u6709\u7528\u6027\u304c\u8fd1\u5e74\u5f37\u8abf\u3055\u308c\u3066\u3044\u308b
\n\u25cf\t\u3053\u308c\u307e\u3067Nonrandomized trial\u3067\u5c0f\u5150\u306e\u524d\u8155\u9060\u4f4d\u9aa8\u6298\u306b\u5bfe\u3059\u308b\u30a8\u30b3\u30fc\u3067\u306e\u8a3a\u65ad\u304c\u6b63\u78ba\u304b\u3064\u30bf\u30a4\u30e0\u30ea\u30fc\u3067\u3001\u88ab\u7206\u306e\u70b9\u304b\u3089\u3082\u6709\u7528\u3067\u3042\u308b\u3053\u3068\u306f\u793a\u3055\u308c\u3066\u3044\u305f
\n\u25cf\t\u305f\u3060\u3001\u3053\u308c\u307e\u3067\u306f\u9aa8\u6298\u306e\u521d\u671f\u8a3a\u65ad\u306b\u304a\u3051\u308b\u30a8\u30b3\u30fc\u306e\u6d3b\u7528\u304c\u3001Xp\u3068\u6bd4\u8f03\u3057\u3001\u30a2\u30a6\u30c8\u30ab\u30e0\u3068\u3057\u3066\u306e\u8155\u306e\u904b\u52d5\u6a5f\u80fd\u3068\u3044\u3046\u70b9\u3067\u975e\u52a3\u6027\u3067\u3042\u308b\u304b\u3069\u3046\u304b\u306f\u691c\u8a0e\u3055\u308c\u3066\u3044\u306a\u304b\u3063\u305f
\n\u25cf\t\u4eca\u56de\u3001\u6551\u6025\u306e\u73fe\u5834\u3067\u306e\u5c0f\u5150\u30fb\u82e5\u5e74\u8005\u306e\u9aa8\u6298\u306e\u521d\u671f\u8a3a\u65ad\u306b\u304a\u3044\u3066\u3001\u4e2d\u671f\u7684\u306a\u904b\u52d5\u6a5f\u80fd\u3068\u3044\u3046\u89b3\u70b9\u3067\u30a8\u30b3\u30fc\u304cXp\u3068\u6bd4\u8f03\u3057\u3066\u6709\u7528\u3067\u3042\u308b\u304b\u306b\u3064\u3044\u3066randomized trial\u3092\u5b9f\u65bd\u3057\u305f\u7d50\u679c\u3092\u5831\u544a\u3059\u308b<\/p>\n

Method
\n<\u5bfe\u8c61>
\n\u25cf\t\u30aa\u30fc\u30b9\u30c8\u30e9\u30ea\u30a2\u306e\uff14\u65bd\u8a2d\u5171\u540c\u3067\u3001open-label, noninferiority, randomized, controlled trial\u3092\u5b9f\u65bd\u3002
\n\u25cf\t\u65bd\u8a2d\u306f\u3001large territory \u306e\u5c0f\u5150\u75c5\u9662\u3001\u5927\u5b66\u75c5\u9662\u3001\u6df7\u5408\u75c5\u9662\u304c\u542b\u307e\u308c\u305f
\n\u25cf\t\u6551\u6025\u5916\u6765\u3092\u8a2a\u308c\u305f5~15\u6b73\u306e\u5c0f\u5150\u30fb\u82e5\u5e74\u8005\u304c\u5bfe\u8c61
\n\u25cf\t\u6025\u6027\u671f\u306e\u3001\u8a3a\u5bdf\u4e0a\u5909\u5f62\u304c\u660e\u3089\u304b\u3067\u306f\u306a\u3044\u3001\u524d\u8155\u9aa8\u5358\u72ec\u306e\u5916\u50b7\u3067\u3001\u9aa8\u6298\u304c\u7591\u308f\u308c\u753b\u50cf\u691c\u67fb\u304c\u5fc5\u8981\u306a\u60a3\u8005\u304c\u542b\u307e\u308c\u305f
\n\u25cf\t\u5bfe\u8c61\u8005\u306f\u30011:1\u3067\u30a8\u30b3\u30fc\u7fa4\u3001Xp\u7fa4\u306e2\u7fa4\u306b\u30e9\u30f3\u30c0\u30e0\u5316\u5272\u4ed8\u3055\u308c\u305f<\/p>\n

<\u30d7\u30ed\u30c8\u30b3\u30eb>
\n\u30a8\u30b3\u30fc\u7fa4
\n\u25cf\t\u30c8\u30ec\u30fc\u30cb\u30f3\u30b0\u3055\u308c\u8a8d\u8a3c\u3092\u53d7\u3051\u305f\u6551\u6025\u90e8\u306e\u533b\u7642\u5f93\u4e8b\u8005(Ns practitioner, PT, \u6551\u6025\u533b)\u306b\u3088\u3063\u3066\u30a8\u30b3\u30fc\u3092\u5b9f\u65bd(A modified six-view forearm ultrasonography protocol)\u3002
\n\u25cf\t\u30a8\u30b3\u30fc\u306e\u30bf\u30a4\u30d7\u306f\u30dd\u30fc\u30bf\u30d6\u30eb\u3060\u3063\u305f\u308a\u69d8\u3005
\n\u25cf\t\u30a8\u30b3\u30fc\u5f8c\u306b\u306f\u3001\u9aa8\u6298\u306a\u3057\u3001\u82e5\u6728\u9aa8\u6298\u3001\u305d\u306e\u4ed6\u306e\u9aa8\u6298\u306e\uff13\u3064\u306e\u30bf\u30a4\u30d7\u306b\u5206\u985e\u3055\u308c\u3001\u305d\u306e\u4ed6\u306e\u9aa8\u6298\u306b\u306f\u66f4\u306bincomplete(unicortical or bicortical), complete, \u305d\u3057\u3066Salter-Harris\u9aa8\u6298(\u9aa8\u7aef\u8edf\u9aa8\u677f(\u6210\u9577\u677f)\u306e\u9aa8\u6298)\u306e\uff13\u3064\u3078\u5206\u985e\u3055\u308c\u305f
\n\u25cf\t\u305d\u306e\u4ed6\u306e\u9aa8\u6298\u3001\u306b\u5206\u985e\u3055\u308c\u305f\u5834\u5408\u306b\u306f\u3001\u30a8\u30b3\u30fc\u5f8c\u306bXp\u3082\u5b9f\u65bd\u3001\u9aa8\u6298\u306a\u3057\u30fb\u82e5\u6728\u9aa8\u6298\u306b\u5206\u985e\u3055\u308c\u305f\u5834\u5408\u306b\u306f\u57fa\u672c\u7684\u306b\u305d\u306e\u5f8cXp\u691c\u67fb\u306f\u5b9f\u65bd\u3055\u308c\u306a\u304b\u3063\u305f
\nXp\u7fa4
\n\u25cf\t\u4e8c\u65b9\u5411\u64ae\u5f71\u3055\u308c\u3001\u653e\u5c04\u7dda\u6280\u5e2b\u306b\u3088\u3063\u3066\u64ae\u5f71\u3055\u308c\u3001\u307e\u305a\u306f\u305d\u306e\u5834\u3067\u5bfe\u5fdc\u3057\u305f\u533b\u5e2b\u306b\u3088\u3063\u3066\u8aad\u5f71\u3055\u308c\u305f\u3002(\u5f8c\u65e5\u653e\u5c04\u7dda\u79d1\u533b\u306b\u3088\u3063\u3066\u8aad\u5f71)
\n\u25cf\t\u753b\u50cf\u306f\u9aa8\u6298\u306a\u3057\u3001\u82e5\u6728\u9aa8\u6298\u3001\u305d\u306e\u4ed6\u306e\u9aa8\u6298\u306b\u5206\u985e\u3055\u308c\u305f\u3002<\/p>\n

\u25cf\t\u6700\u7d42\u8a3a\u65ad\u306f\u5c0f\u5150\u653e\u5c04\u7dda\u79d1\u533b\u3001\u5c0f\u5150\u6574\u5f62\u5916\u79d1\u533b\u3001\u5c0f\u5150\u79d1\u306e\u30d5\u30a7\u30ed\u30fc\u30b7\u30c3\u30d7\u30c8\u30ec\u30fc\u30cb\u30f3\u30b0\u3092\u53d7\u3051\u305f\u6551\u6025\u533b\u304b\u3089\u306a\u308b\u5c02\u9580\u5bb6\u30d1\u30cd\u30eb\u306b\u3088\u3063\u3066\u306a\u3055\u308c\u305f\u3002
\n\u25cf\tManagement principles\u306f\u4e21\u7fa4\u9593\u3067\u7d71\u4e00\u3055\u308c\u3001\u521d\u671f\u6cbb\u7642\u306f\u30b5\u30a4\u30c8\u9593\u3067\u6a19\u6e96\u5316\u3055\u308c\u305f\u3002
\n\u25cf\t\u9aa8\u6298\u306a\u3057\u306f\u533b\u5e2b\u306e\u6700\u826f\u3067\u4fdd\u5b58\u7684\u306b\u52a0\u7642\u3055\u308c\u3001\u82e5\u6728\u9aa8\u6298\u306fwrist splint\u3067\u306e\u52a0\u7642\u3001\u305d\u306e\u4ed6\u306e\u9aa8\u6298\u306f\u5fc5\u8981\u306b\u5fdc\u3058\u3066\u5916\u79d1\u7684\u306a\u4ecb\u5165(\u30de\u30cb\u30d4\u30e5\u30ec\u30fc\u30b7\u30e7\u30f3\u3001\u624b\u8853)\u3082\u3057\u304f\u306fcast immobilization\u3092\u53d7\u3051\u305f\u3002<\/p>\n

<\u30a2\u30a6\u30c8\u30ab\u30e0>
\n\u25cf\tPrimary outocome\u306fPROMIS(Patient0-Reported Outcomes Measurement Information System) tool\u3092\u3082\u3068\u306b\u3057\u305f4\u9031\u5f8c\u306e\u8155\u306e\u904b\u52d5\u6a5f\u80fd
\n\u203bPROMIS tool\u306f\u30015\u6b73\u304b\u308915\u6b73\u306e\u5c0f\u5150\u30fb\u82e5\u5e74\u8005\u3092\u5bfe\u8c61\u306b\u30018\u9805\u76ee\u3067\u8155\u306e\u904b\u52d5\u6a5f\u80fd\u3092\u30b9\u30b3\u30a2\u30ea\u30f3\u30b0\u3059\u308b\u30c4\u30fc\u30eb\u30018\uff5e40\u70b9\u3067\u3001\u70b9\u6570\u304c\u9ad8\u3044\u307b\u3069\u826f\u3044\u3002\u4eca\u56de\u306f5\u70b9\u4ee5\u4e0a\u306e\u5dee\u3092\u512a\u4f4d\u3068\u3057\u305f\u3002
\n\u25cf\tKey secondary outcome\u306f\u3001\u521d\u671f\u8a3a\u65ad\u6642\u306b\u82e5\u6728\u9aa8\u6298\u3067\u3042\u3063\u305f\u60a3\u8005(expert panel\u3067\u78ba\u5b9a)\u306e4\u9031\u5f8c\u306e\u8155\u306e\u904b\u52d5\u6a5f\u80fd
\n\u25cf\t\u305d\u306e\u4ed6\u306esecondary outcom\u3068\u3057\u3066\u306f\u30011\u9031\u30fb8\u9031\u5f8c\u306e\u904b\u52d5\u6a5f\u80fd\u30014\u9031\u30fb8\u9031\u5f8c\u306e\u6e80\u8db3\u5ea6(5-point Likert scale\u3067\u8a55\u4fa1)\u30011,4,8\u9031\u5f8c\u306e\u75bc\u75db(6-point Faces Pain Scale-Revised tool\u3067\u8a55\u4fa1)\u3001\u5408\u4f75\u75c7\u306e\u983b\u5ea6\u3001Xp\u64ae\u5f71\u306e\u983b\u5ea6\u3001\u6551\u6025\u5916\u6765\u6ede\u5728\u6642\u9593\u3092\u8a2d\u5b9a
\n\u25cf\tPrimary analysis\u306f\u7dda\u5f62\u56de\u5e30\u30e2\u30c7\u30eb\u3092\u7528\u3044\u3066\u5206\u6790\u3055\u308c\u305f<\/p>\n

Result
\n\u25cf\t2020\u5e749\u6708\u304b\u30892021\u5e7411\u6708\u307e\u3067\u3001total 270\u540d\u304c\u30e9\u30f3\u30c0\u30e0\u5316\u5272\u4ed8\u3055\u308c\u305f\u3002135\u304c\u30a8\u30b3\u30fc\u7fa4\u3001135\u304cXp\u7fa4\u3078\u3002Primary outcome data\u306f\u30a8\u30b3\u30fc\u7fa4130\u540d\u3001Xp\u7fa4132\u540d\u3067\u8a55\u4fa1\u3067\u304d\u305f
\n\u25cf\t\u30d9\u30fc\u30b9\u30e9\u30a4\u30f3\u306fTable1\u306e\u901a\u308a
\n\"\"<\/a><\/p>\n

\u25cf\t\u8a3a\u65ad\u30ab\u30c6\u30b4\u30ea\u30fc2\u7fa4\u9593\u3067\u5dee\u306f\u306a\u3057
\n\u25cf\t\u30a8\u30b3\u30fc\u7fa4\u306e\u3046\u306140\u540d\u304cXp\u3082\u5b9f\u65bd\u3057\u305f
\n\u25cf\t\u6551\u6025\u5916\u6765\u3067\u306e\u30de\u30cd\u30b8\u30e1\u30f3\u30c8\u30822\u7fa4\u9593\u3067\u5927\u304d\u306a\u5dee\u306f\u306a\u3044\u3082\u306e\u306e\u3001\u30ae\u30d7\u30b9\u56fa\u5b9a\u306f\u30a8\u30b3\u30fc\u7fa4\u3067\u3084\u3084\u5c11\u306a\u3044(\u30a8\u30b3\u30fc\u7fa423%, Xp\u7fa432%)<\/p>\n

\uff1cPrimary outcome\uff1e<\/p>\n

\"\"<\/a><\/p>\n

\u25cf\t4\u9031\u5f8c\u306ePROMIS score\u306f\u30a8\u30b3\u30fc\u3001Xp\u7fa4\u3067\u305d\u308c\u305d\u308c36.4\u00b15.9, 36.3\u00b15.3\u70b9(mean difference, 0.1 point; 95% CI -1.3 to 1.4)
\n\u25cf\tITT analysis\u3067\u3082\u540c\u69d8\u306e\u7d50\u679c<\/p>\n

\uff1cSecondary outcome\uff1e<\/p>\n

\u25cf\t1\u9031\u30fb8\u9031\u9593\u5f8c\u306ePROMIS score\u3067\uff12\u7fa4\u9593\u3067\u6709\u610f\u5dee\u306a\u3057
\n\u25cf\t4\u9031\u30fb8\u9031\u9593\u5f8c\u306e\u60a3\u8005\u3082\u3057\u304f\u306f\u30b1\u30a2\u30ae\u30d0\u30fc\u306e\u6e80\u8db3\u5ea6\u306f\u30a8\u30b3\u30fc\u7fa4\u3067\u512a\u308c\u308b
\n\u25cf\t\u30a8\u30b3\u30fc\u7fa4\u3067\u6551\u6025\u5916\u6765\u6ede\u5728\u6642\u9593\u304c\u77ed\u3044
\n\u25cf\t\u6709\u5bb3\u4e8b\u8c61\u306e\u983b\u5ea6\u3001\u4e88\u7d04\u5916\u3067(\u60f3\u5b9a\u5916\u3067)\u6551\u6025\u5916\u6765\u3078\u5e30\u3063\u3066\u304f\u308b\u5272\u5408\u306f2\u7fa4\u9593\u3067\u6709\u610f\u5dee\u306a\u3057<\/p>\n

Discussion<\/p>\n

\u25cf\t\u6551\u6025\u5916\u6765\u3067\u306e\u691c\u8a0e\u3067\u3042\u308a\u3001\u65bd\u8a2d\u3082\u5927\u75c5\u9662\u306b\u9650\u3089\u308c\u3066\u3044\u308b\u305f\u3081\u3001\u4eca\u5f8c\u306f\u30d7\u30e9\u30a4\u30de\u30ea\u30fb\u30b1\u30a2\u306e\u30bb\u30c3\u30c6\u30a3\u30f3\u30b0\u306a\u3069\u3067\u306e\u691c\u8a0e\u304c\u81e8\u307e\u308c\u308b
\n\u25cf\t\u672c\u7814\u7a76\u306e\u9650\u754c\u3068\u3057\u3066\u3001\u521d\u671f\u8a3a\u65ad\u65b9\u6cd5\u3068\u306f\u5225\u306b\u3001\u305d\u306e\u5f8c\u306e\u6cbb\u7642\u7684\u4ecb\u5165\u306e\u9055\u3044\u304c\u30d7\u30e9\u30a4\u30de\u30ea\u30a2\u30a6\u30c8\u30ab\u30e0\u306b\u5f71\u97ff\u3092\u4e0e\u3048\u308b\u3053\u3068\u304c\u8003\u3048\u3089\u308c\u308b\u3002\u305f\u3060\u3057\u3001\u4e8c\u7fa4\u9593\u3067\u8a3a\u65ad\u30ab\u30c6\u30b4\u30ea\u30fc\u3054\u3068\u306e\u521d\u671f\u6cbb\u7642\u7b49\u306b\u5dee\u306f\u898b\u3089\u308c\u306a\u304b\u3063\u305f
\n\u25cf\t\u307e\u305f\u3001\u65bd\u8a2d\u304c\u5c11\u306a\u304f\u3001\u5c11\u6570\u306e\u6551\u6025\u533b\u306b\u3088\u3063\u3066\u30c8\u30ec\u30fc\u30cb\u30f3\u30b0\u3055\u308c\u305f\u533b\u7642\u5f93\u4e8b\u8005\u304c\u5b9f\u65bd\u3057\u3066\u3044\u308b\u3053\u3068\u3082\u9650\u754c\u306e\u4e00\u3064\u3002
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