Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Eur J Radiol. 2012 Dec;81(12):4019-28. doi: 10.1016/j.ejrad.2012.06.021. Epub 2012 Sep 10.
The aim of this systematic review was to compare the diagnostic accuracy, subjective image quality and clinical consequences of 3D-fluoroscopy with standard imaging modalities (2D-fluoroscopy, X-ray or CT) during reduction and fixation of intra-articular upper and lower extremity fractures.
A systematic literature search was performed in MEDLINE, EMBASE and the Cochrane library. In total 673 articles were identified (up to March 2012). The 19 included studies described patients/cadavers with intra-articular upper/lower extremity fractures and compared 3D-fluoroscopy to standard imaging. The study was performed in accordance with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) guidelines. Diagnostic accuracy was defined by the quality of fracture reduction or implant position and, if possible, expressed as sensitivity and specificity; subjective image quality was determined by the quality of depiction of bone or implants; clinical consequences were defined as corrections in reduction or implant position following 3D-fluoroscopy.
Ten cadaver- and nine clinical studies were included. A meta-analysis was not possible, because studies used different scoring protocols to express diagnostic accuracy and reported incomplete data. Based on the individual studies, diagnostic accuracy of 3D-fluoroscopy was better than 2D-fluoroscopy and X-ray, but similar to CT-scanning. Subjective image quality of 3D-fluoroscopy was inferior compared to all other imaging modalities. In 11-40% of the operations additional corrections were performed after 3D-fluoroscopy, while the necessity for these corrections were not recognized based on 2D-fluoroscopic images.
Although subjective image quality is rated inferior compared to other imaging modalities, intra-operative use of 3D-fluoroscopy is a helpful diagnostic tool for improving the quality of reduction and implant position in intra-articular fractures.
本系统评价旨在比较三维透视与标准成像方式（二维透视、X 射线或 CT）在关节内上肢和下肢骨折复位和固定中的诊断准确性、主观图像质量和临床后果。
系统检索 MEDLINE、EMBASE 和 Cochrane 图书馆，共检索到 673 篇文章（截至 2012 年 3 月）。19 项纳入的研究描述了关节内上肢/下肢骨折患者/尸体，并将三维透视与标准成像进行了比较。该研究符合诊断准确性研究质量评估（QUADAS）指南。诊断准确性由骨折复位或植入物位置的质量定义，如果可能的话，用敏感性和特异性来表示；主观图像质量由骨或植入物的显示质量来确定；临床后果定义为三维透视后复位或植入物位置的纠正。
纳入了 10 项尸体和 9 项临床研究。由于研究使用不同的评分方案来表达诊断准确性并报告不完整的数据，因此无法进行荟萃分析。基于个别研究，三维透视的诊断准确性优于二维透视和 X 射线，但与 CT 扫描相似。与其他所有成像方式相比，三维透视的主观图像质量较差。在 11%-40%的手术中，在进行三维透视后需要进行额外的纠正，而这些纠正的必要性在二维透视图像上无法识别。
尽管主观图像质量与其他成像方式相比较差，但术中使用三维透视是一种有助于提高关节内骨折复位和植入物位置质量的诊断工具。
