Lee In Sook, Choi Jung-Ah, Kim Tae Kyun, Han Ilkyu, Lee Joon Woo, Kang Heung Sik
Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeongi-do 463-707, Korea.
AJR Am J Roentgenol. 2006 Jun;186(6):1778-82. doi: 10.2214/AJR.05.1191.
The aim of our study was to determine how consistent measurements of the distal femoral condyle on 16-MDCT are with intraoperative measurements and the reliability of 16-MDCT for the preoperative planning of total knee arthroplasty.
Between August 2003 and March 2004, 33 consecutive patients (two men and 31 women; age range, 53-89 years; mean age, 71 years) presenting with osteoarthritis underwent 16-MDCT (Mx 8000 IDT) of a total of 53 knees before total knee arthroplasty. The prospective analysis included measurements of transepicondylar distance, maximum anteroposterior dimension of medial and lateral femoral condyles, and trochlear width on a Rapidia workstation. To increase reliability, we repeated the measurements on a CT workstation after 2 months and compared them with the previous values. The values measured on the CT workstation were compared with the measurements obtained in the intraoperative field. Statistical analysis was performed using kappa statistics. A p value of less than 0.05 was considered statistically significant.
The mean values of transepicondylar distance, maximum anteroposterior dimension of medial and lateral femoral condyles, and trochlear width were 75, 57, 58, and 38 mm at first measurement; 76, 58, 59, and 39 mm at second measurement on the CT workstation; and 79, 57, 60, and 42 mm at intraoperative measurement, respectively. At reliability analysis between the first measurements on the CT workstation and the intraoperative measurements, kappa values were 0.84 for the transepicondylar distance, 0.81 for the maximum anteroposterior dimension of the medial femoral condyle, 0.89 for the maximum anteroposterior dimension of the lateral femoral condyle, and 0.62 for the trochlear width. The kappa values for the second measurements were 0.86, 0.77, 0.84, and 0.61, respectively. Intraoperative measurements and measured values on the CT workstation showed excellent and almost perfect agreement, and intraobserver agreement was almost perfect.
Femoral sizing on a CT workstation had excellent or almost perfect correlation with intraoperative measurements. Therefore, reliable preoperative planning for total knee arthroplasty may be done with 16-MDCT and an advanced workstation.
本研究的目的是确定16层螺旋CT（16-MDCT）对股骨远端髁的测量结果与术中测量结果的一致性，以及16-MDCT在全膝关节置换术前规划中的可靠性。
2003年8月至2004年3月，33例连续的骨关节炎患者（2例男性，31例女性；年龄范围53 - 89岁；平均年龄71岁）在全膝关节置换术前接受了16-MDCT（Mx 800 IDT）检查，共涉及53个膝关节。前瞻性分析包括在Rapidia工作站上测量髁间距离、股骨内外侧髁的最大前后径以及滑车宽度。为提高可靠性，2个月后在CT工作站上重复测量，并与之前的值进行比较。将CT工作站上测量的值与术中测量值进行比较。采用kappa统计进行统计分析。p值小于0.05被认为具有统计学意义。
髁间距离、股骨内外侧髁的最大前后径以及滑车宽度的首次测量平均值分别为75、57、58和38mm；CT工作站上第二次测量值分别为76、58、59和39mm；术中测量值分别为79、57、60和42mm。在CT工作站首次测量值与术中测量值的可靠性分析中，髁间距离的kappa值为0.84，股骨内侧髁最大前后径的kappa值为0.81，股骨外侧髁最大前后径的kappa值为0.89，滑车宽度的kappa值为0.62。第二次测量的kappa值分别为0.86、0.77、0.84和0.61。术中测量值与CT工作站测量值显示出极好且几乎完美的一致性，观察者内一致性几乎完美。
CT工作站上的股骨尺寸测量与术中测量具有极好或几乎完美的相关性。因此，使用16-MDCT和先进的工作站可以进行可靠的全膝关节置换术前规划。
