Ladd Amy L, Messana Joseph M, Berger Aaron J, Weiss Arnold-Peter C
Robert A. Chase Hand & Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA; Department of Orthopaedics, Warren Alpert Medical School at Brown University, Providence, RI.
Robert A. Chase Hand & Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA; Department of Orthopaedics, Warren Alpert Medical School at Brown University, Providence, RI.
J Hand Surg Am. 2015 Mar;40(3):474-82. doi: 10.1016/j.jhsa.2014.11.021. Epub 2015 Jan 21.
To determine if a slight modification of the 1987 Eaton-Glickel staging and interpreting 4 standardized radiographs for trapeziometacarpal (TMC) osteoarthritis (OA) improved analysis, to determine if a quantifiable index measurement from a single Robert (pronated anteroposterior) view enhanced reproducibility, and to examine whether improved radiographic staging correlated to clinically relevant disease and thus support validity.
We analyzed 4 thumb radiographs (posteroanterior, lateral, Robert, and stress views) in 60 consecutive subjects representing an adult population spectrum of asymptomatic to advanced disease. Two experienced hand surgeons (A.L.L. and A.P.C.W.), 1 chief resident (A.J.B.), and 1 medical student (J.M.M.) performed the analysis on each subject's radiographs. We analyzed all 4 radiographs for Eaton and modified Eaton staging and then later analyzed only the Robert view for the thumb osteoarthritis (ThOA) index measurement. The radiographs were randomized and reread a week later for each classification at separate times. Surgically excised trapeziums from 20/60 subjects were inspected for first metacarpal surface disease and correlated to the 3 classifications.
All 3 staging classifications demonstrated high reproducibility, with the intraclass correlation coefficient averaging 0.73 for the Eaton, 0.83 for the modified Eaton, and 0.95 for the ThOA index. Articular wear and metacarpal surface eburnation correlated highest to the ThOA index, with advanced disease 1.55 or greater correlating to Eaton III/IV and modified Eaton stage 3/4 in a linear relationship.
The ThOA index based on a Robert view provided a measurable alternative to Eaton staging and correlated to severity of surgically relevant thumb TMC OA.
A simple reproducible radiographic measurement may enhance TMC OA classification and provide a reliable means to predict clinical disease.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.
确定对1987年伊顿 - 格利克尔分期进行轻微修改并解读4张标准化的大多角骨 - 第一掌骨（TMC）骨关节炎（OA）X线片是否能改善分析，确定从单一罗伯特位（旋前前后位）X线片获得的可量化指标测量是否能提高可重复性，并检查改进后的X线分期是否与临床相关疾病相关，从而支持其有效性。
我们分析了60名连续受试者的4张拇指X线片（正位、侧位、罗伯特位和应力位），这些受试者代表了从无症状到晚期疾病的成人群体范围。两名经验丰富的手外科医生（A.L.L.和A.P.C.W.）、一名住院总医师（A.J.B.）和一名医学生（J.M.M.）对每个受试者的X线片进行分析。我们对所有4张X线片进行伊顿分期和改良伊顿分期分析，随后仅对罗伯特位X线片进行拇指骨关节炎（ThOA）指数测量分析。X线片随机分组，一周后在不同时间对每个分类进行重新解读。对60名受试者中20名的手术切除大多角骨检查第一掌骨表面疾病情况，并与三种分类进行关联。
所有三种分期分类均显示出高可重复性，伊顿分期的组内相关系数平均为0.73，改良伊顿分期为0.83，ThOA指数为0.95。关节磨损和掌骨表面骨质象牙样变与ThOA指数的相关性最高，晚期疾病（ThOA指数为1.55或更高）与伊顿III/IV期和改良伊顿3/4期呈线性关系。
基于罗伯特位X线片的ThOA指数为伊顿分期提供了一种可测量的替代方法，并且与手术相关的拇指TMC OA的严重程度相关。
一种简单可重复的X线测量方法可能会改善TMC OA的分类，并提供一种预测临床疾病的可靠手段。
研究类型/证据水平：诊断性研究II级。
