Scalise Jason J, Codsi Michael J, Bryan Jason, Brems John J, Iannotti Joseph P
The CORE Institute, 3010 West Agua Fria Freeway, Suite 100, Phoenix, AZ 85027, USA.
J Bone Joint Surg Am. 2008 Nov;90(11):2438-45. doi: 10.2106/JBJS.G.01341.
Arthritic changes to glenoid morphology can be difficult to fully characterize on both plain radiographs and conventional two-dimensional computer tomography images. We tested the hypothesis that three-dimensional imaging of the shoulder would increase inter-rater agreement for assessing the extent and location of glenoid bone loss and also would improve surgical planning for total shoulder arthroplasty.
Four shoulder surgeons independently and retrospectively reviewed the preoperative computed tomography scans of twenty-four arthritic shoulders. The blinded images were evaluated with conventional two-dimensional imaging software and then later with novel three-dimensional imaging software. Measurements and preoperative judgments were made for each shoulder with use of each imaging modality and then were compared. The glenoid measurements were glenoid version and bone loss. The judgments were the zone of maximum glenoid bone loss, glenoid implant fit within the glenoid vault, and how to surgically address abnormal glenoid version and bone loss. Agreement between observers was evaluated with use of intraclass correlation coefficients and the weighted kappa coefficient (kappa), and we determined if surgical decisions changed with use of the three-dimensional data.
The average glenoid version (and standard deviation) measured -17 degrees +/- 2.2 degrees on the two-dimensional images and -19 degrees +/- 2.4 degrees on the three-dimensional images (p < 0.05). The average posterior glenoid bone loss measured 9 +/- 2.3 mm on the two-dimensional images and 7 +/- 2 mm on the three-dimensional images (p < 0.05). The average anterior bone loss measured 1 mm on both the two-dimensional and the three-dimensional images. However, the intraclass correlation coefficients for anterior bone loss increased significantly with use of the three-dimensional data (from 0.36 to 0.70; p < 0.05). Observers were more likely to locate mid-anterior glenoid bone loss on the basis of the three-dimensional data (p < 0.05). The use of three-dimensional data provided greater agreement among observers with regard to the zone of glenoid bone loss, glenoid prosthetic fit, and surgical decision-making. Also, when the judgment of implant fit changed, observers more often determined that it would violate the vault walls on the basis of the three-dimensional data (p < 0.05).
The use of three-dimensional imaging can increase inter-rater agreement for the analysis of glenoid morphology and preoperative planning. Important considerations such as the extent and location of glenoid bone loss and the likelihood of implant fit were influenced by the three-dimensional data.
在普通X线片和传统二维计算机断层扫描图像上，肩胛盂形态的关节炎性改变可能难以完全特征化。我们检验了这样一个假设，即肩部的三维成像将提高评估肩胛盂骨质流失程度和位置的观察者间一致性，并且还将改善全肩关节置换术的手术规划。
四位肩部外科医生独立且回顾性地分析了24例患有关节炎的肩部的术前计算机断层扫描。对这些不知情的图像先用传统二维成像软件进行评估，随后再用新型三维成像软件进行评估。使用每种成像方式对每个肩部进行测量和术前判断，然后进行比较。肩胛盂测量指标为肩胛盂倾斜度和骨质流失。判断内容包括肩胛盂骨质流失最严重的区域、肩胛盂假体在肩胛盂穹顶内的适配情况，以及如何通过手术解决异常的肩胛盂倾斜度和骨质流失问题。使用组内相关系数和加权kappa系数（kappa）评估观察者之间的一致性，并且我们确定手术决策是否因使用三维数据而改变。
二维图像上测得的平均肩胛盂倾斜度（及标准差）为-17°±2.2°，三维图像上为-19°±2.4°（p<0.05）。二维图像上测得的肩胛盂后部平均骨质流失为9±2.3mm，三维图像上为7±2mm（p<0.05）。二维和三维图像上测得的前部骨质流失均为1mm。然而，使用三维数据时，前部骨质流失的组内相关系数显著增加（从0.36增至0.70；p<0.05）。观察者更有可能基于三维数据确定肩胛盂前部中间的骨质流失位置（p<0.05）。使用三维数据在肩胛盂骨质流失区域、肩胛盂假体适配情况和手术决策方面，观察者之间的一致性更高。此外，当假体适配的判断发生变化时，观察者更常基于三维数据确定其会侵犯穹顶壁（p<0.05）。
使用三维成像可提高观察者间对肩胛盂形态分析和术前规划的一致性。肩胛盂骨质流失的程度和位置以及假体适配可能性等重要考量因素受到三维数据的影响。
