Lowe Jason B, Monazzam Shafagh, Walton Blaine, Nelson Elisha, Wolinsky Philip R
*Division of Orthopaedic Surgery, University of Alabama, Birmingham, AL; and †Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA.
J Orthop Trauma. 2015 Oct;29(10):e401-7. doi: 10.1097/BOT.0000000000000333.
Intraarticular screw perforation is a common complication of open reduction and internal fixation of proximal humerus fractures. The purpose of this study was to (1) determine the sensitivity and specificity of the fluoroscopic images used to evaluate whether a screw tip has perforated into the glenohumeral joint, and (2) determine the specific fluoroscopic views that best evaluate screw position in the humeral head.
Twenty-two proximal humeri in 11 lightly embalmed cadavers were instrumented. The articular surface was divided into equal-sized rows (superior, central, inferior) and columns (anterior, middle, posterior). The screws in 10 humeri were inserted and so their tips were located 2 mm beneath the articular surface. Twelve humeri had screws placed such that their tips protruded 2 mm past the articular surface into the glenohumeral joint. Twenty-seven different C-arm views were obtained of each specimen/screw configuration.
There were zero false-positives (100% specificity). The average sensitivity was 55% and varied greatly depending on the image view and the screw exit location (range, 0%-100%). The sensitivity for the inferior row of screws was the lowest (39.1%) and was particularly low for the posterior-inferior screw exit location (20.7%).
Screws that are completely located within the bone of the proximal humerus will never appear on C-arm images as intraarticular. However, screws that are intraarticular may appear to be completely located within the bone of the proximal humerus on some C-arm images. A sensitivity of 100% for detecting intraarticular screws for 8 of the 9 screws' exit locations and 90% for the posterior-inferior screw can be achieved by imaging the proximal humerus in 25-degree internal rotation, neutral, and 25-degree external rotation with the C-arm in neutral cant at rainbow 25-degree roll over, neutral rainbow, and rainbow 25-degree roll back for a total of 9 images.
关节内螺钉穿孔是肱骨近端骨折切开复位内固定术的常见并发症。本研究的目的是：（1）确定用于评估螺钉尖端是否穿入盂肱关节的透视图像的敏感性和特异性；（2）确定能最佳评估肱骨头螺钉位置的具体透视角度。
对11具轻度防腐尸体的22个肱骨近端进行器械操作。将关节面分为大小相等的行（上、中、下）和列（前、中、后）。在10个肱骨中插入螺钉，使其尖端位于关节面下方2毫米处。在12个肱骨中放置螺钉，使其尖端穿过关节面2毫米突入盂肱关节。对每个标本/螺钉配置获取27种不同的C形臂视图。
假阳性为零（特异性100%）。平均敏感性为55%，因图像视图和螺钉穿出位置而异（范围为0% - 100%）。螺钉下排的敏感性最低（39.1%），后下螺钉穿出位置的敏感性尤其低（20.7%）。
完全位于肱骨近端骨内的螺钉在C形臂图像上绝不会显示为关节内螺钉。然而，关节内的螺钉在某些C形臂图像上可能看似完全位于肱骨近端骨内。通过在C形臂处于中性倾斜、彩虹25度翻转、中性彩虹和彩虹25度回滚状态下，将肱骨近端以25度内旋、中立位和25度外旋成像，共获取9张图像，对于9个螺钉穿出位置中的8个，检测关节内螺钉的敏感性可达100%，对于后下螺钉可达90%。
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