Division of Orthopedic Surgery, University of Western Ontario, Hand and Upper Limb Centre, London, Ontario, Canada.
J Shoulder Elbow Surg. 2010 Dec;19(8):1145-9. doi: 10.1016/j.jse.2010.04.047. Epub 2010 Aug 12.
Circumstances occur when the determination of anatomic humeral head version is difficult. In the setting of irreparable proximal humeral fracture, there are few reliable intraoperative landmarks to determine anatomic humeral head version. This study tested our hypothesis that the metaphyseal version (metaversion) is a landmark that can assist with correct head version and used computed tomography (CT) to evaluate its reliability as a predictor of anatomic version.
CT scans from 50 consecutive patients (20 women, 30 men) were examined using commercial software. Patients were a mean age of 46 years (range, 17-85 years). Exclusion criteria included previous fracture, arthritis, or humeral deformity. The metaversion and humeral head version were measured. Measurements were conducted independently by 2 surgeons blinded to the results of the other. Interobserver and intraobserver reliability was calculated using intraclass correlation.
The mean difference between the metaversion and the humeral head version was 2.5° (95% confidence interval [CI], 0.9°-3.9°). The mean difference between metaversion and humeral head version was 1.8° (95% CI, 0.0°-3.6°) in women, 2.9° (95% CI, 0.6°-5.1°) in men, 2.4° (95% CI: 0.6°-4.1°) in right shoulders, and 2.5° (95% CI, -0.1° to 5.1°) in left shoulders. Interrater and intrarater reliability was excellent, 0.97 and 0.98, respectively.
Proximal humeral metaphyseal version (metaversion) is an accurate predictor of ipsilateral humeral head version.
在确定解剖肱骨头版本有困难的情况下，会出现一些情况。在不可修复的肱骨近端骨折的情况下，很少有可靠的术中标志来确定解剖肱骨头版本。本研究检验了我们的假设，即干骺端版本（metaversion）是一个可以辅助正确头版本的标志，并使用计算机断层扫描（CT）来评估其作为解剖版本预测指标的可靠性。
使用商业软件检查了 50 例连续患者（20 名女性，30 名男性）的 CT 扫描。患者的平均年龄为 46 岁（范围，17-85 岁）。排除标准包括先前骨折、关节炎或肱骨畸形。测量干骺端版本和肱骨头版本。两位外科医生在不知道其他结果的情况下独立进行测量。使用组内相关系数计算观察者间和观察者内可靠性。
metaversion 和肱骨头版本之间的平均差异为 2.5°（95%置信区间[CI]，0.9°-3.9°）。女性的 metaversion 和肱骨头版本之间的平均差异为 1.8°（95% CI，0.0°-3.6°），男性为 2.9°（95% CI，0.6°-5.1°），右侧为 2.4°（95% CI：0.6°-4.1°），左侧为 2.5°（95% CI，-0.1°-5.1°）。观察者间和观察者内可靠性均为优秀，分别为 0.97 和 0.98。
肱骨近端干骺端版本（metaversion）是同侧肱骨头版本的准确预测指标。
