Sasyniuk Treny M, Mohtadi Nicholas G H, Hollinshead Robert M, Russell Margaret L, Fick Gordon H
Sport Medicine Centre, University of Calgary, Calgary, Alberta, Canada.
Arthroscopy. 2007 Sep;23(9):971-7. doi: 10.1016/j.arthro.2007.03.005. Epub 2007 Jun 14.
The purpose of this study was to determine the inter-rater reliability of orthopaedic shoulder surgeons in evaluating the intra-articular structures involved in real-time diagnostic shoulder arthroscopy by use of a videotape model.
Twenty patients (nineteen male patients and one female patient) diagnosed with recurrent anterior shoulder instability with a mean age of 27.9 years (range, 15 to 44 years) consented to participate in the study. Standardized diagnostic shoulder arthroscopies (modified Snyder protocol) were done by a single experienced surgeon, and the procedures were videotaped. The patients' clinical information, radiographs, and videotape of the arthroscopy were sent to 6 experienced shoulder surgeons. The surgeons reviewed the clinical information, assessed the intra-articular structures shown on the videotape, and recorded their diagnoses on a standardized data collection form. The primary outcome was the median overall percent agreement for the video review surgeons by structure evaluated.
The median values for overall agreement for the video review surgeons were as follows: anterior labrum, 90%; inferior labrum, 75%; superior labrum, 60%; posterior labrum, 65%; superior glenohumeral ligament, 50%; middle glenohumeral ligament, 50%; anterior inferior glenohumeral ligament, 25%; glenoid surface, 35%; detection of Hill-Sachs lesion, 85%; biceps tendon, 70%; supraspinatus tendon, 85%; infraspinatus tendon, 70%; and subscapularis tendon, 80%.
The inter-rater reliability for orthopaedic shoulder surgeons' arthroscopic assessment of intra-articular anatomy in patients with anterior shoulder instability varied by structure examined. It was very good (>80%) for the anterior labrum and supraspinatus tendon and in detecting a Hill-Sachs lesion, poor (<40%) for the glenoid and anterior inferior glenohumeral ligament, and intermediate for all other structures examined.
Level V, diagnostic study, expert opinion.
本研究旨在通过录像带模型确定骨科肩关节外科医生在评估实时诊断性肩关节关节镜检查中涉及的关节内结构时的评分者间信度。
20例诊断为复发性肩关节前不稳定的患者（19例男性患者和1例女性患者）同意参与本研究，平均年龄27.9岁（范围15至44岁）。由一名经验丰富的外科医生进行标准化的诊断性肩关节关节镜检查（改良的斯奈德方案），并对手术过程进行录像。将患者的临床信息、X线片和关节镜检查录像发送给6名经验丰富的肩关节外科医生。外科医生查看临床信息，评估录像中显示的关节内结构，并在标准化的数据收集表上记录他们的诊断。主要结果是视频评估外科医生根据评估结构得出的总体一致率中位数。
视频评估外科医生总体一致率的中位数如下：前盂唇，90%；下盂唇，75%；上盂唇，60%；后盂唇，65%；肩胛上韧带，50%；中盂肱韧带，50%；下盂肱前韧带，25%；关节盂表面，35%；Hill-Sachs损伤的检出率，85%；肱二头肌肌腱，70%；冈上肌腱，85%；冈下肌腱，70%；肩胛下肌腱，80%。
骨科肩关节外科医生对肩关节前不稳定患者关节内解剖结构的关节镜评估的评分者间信度因检查结构而异。对于前盂唇和冈上肌腱以及检测Hill-Sachs损伤，信度非常好（>80%）；对于关节盂和下盂肱前韧带，信度较差（<40%）；对于所有其他检查结构，信度为中等。
V级，诊断性研究，专家意见。
