Haller Justin M, O'Toole Robert, Graves Matthew, Barei David, Gardner Michael, Kubiak Erik, Nascone Jason, Nork Sean, Presson Angela P, Higgins Thomas F
Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, United States.
R Adams Cowley Shock Trauma Center, Department of Orthopaedic Surgery, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, United States.
Injury. 2015 Nov;46(11):2243-7. doi: 10.1016/j.injury.2015.06.043. Epub 2015 Jul 10.
While there is conflicting evidence regarding the importance of anatomic reduction for tibial plateau fractures, there are currently no studies that analyse our ability to grade reduction based on fluoroscopic imaging. The purpose of this study was to determine the accuracy of fluoroscopy in judging tibial plateau articular reduction.
Ten embalmed human cadavers were selected. The lateral plateau was sagitally sectioned, and the joint was reduced under direct visualization. Lateral, anterior-posterior (AP), and joint line fluoroscopic views were obtained. The same fluoroscopic views were obtained with 2mm displacement and 5mm displacement. The images were randomised, and eight orthopaedic traumatologists were asked whether the plateau was reduced. Within each pair of conditions (view and displacement from 0mm to 5mm) sensitivity, specificity, and intraclass correlations (ICC) were evaluated.
The AP-lateral view with 5mm displacement yielded the highest accuracy for detecting reduction at 90% (95% CI: 83-94%). For the other conditions, accuracy ranged from (37-83%). Sensitivity was highest for the reduced lateral view (79%, 95% CI: 57-91%). Specificity was highest in the AP-lateral view 98% (95% CI: 93-99%) for 5mm step-off. ICC was perfect for the AP-lateral view with 5mm displacement, but otherwise agreement ranged from poor to moderate at ICC=0.09-0.46. Finally, there was no additional benefit to including the joint-line view with the AP and lateral views.
Using both AP and lateral views for 5mm displacement had the highest accuracy, specificity, and ICC. Outside of this scenario, agreement was poor to moderate and accuracy was low. Applying this clinically, direct visualization of the articular surface may be necessary to ensure malreduction less than 5mm.
尽管关于胫骨平台骨折解剖复位的重要性存在相互矛盾的证据，但目前尚无研究分析我们基于透视成像对复位进行分级的能力。本研究的目的是确定透视在判断胫骨平台关节面复位方面的准确性。
选择10具防腐处理的人体尸体。将外侧平台矢状切开，并在直视下进行关节复位。获取外侧、前后位（AP）和关节线透视图像。在移位2mm和5mm的情况下获取相同的透视图像。图像随机排列，8名骨科创伤专家被问及平台是否已复位。在每对条件（视图和从0mm到5mm的移位）下，评估敏感性、特异性和组内相关性（ICC）。
移位5mm的AP-外侧视图在检测复位方面的准确性最高，为90%（95%CI：83-94%）。对于其他条件，准确性范围为（37-83%）。复位后的外侧视图敏感性最高（79%，95%CI：57-91%）。对于5mm的台阶样移位，AP-外侧视图的特异性最高，为98%（95%CI：93-99%）。对于移位5mm的AP-外侧视图，ICC为完美，但在其他情况下，一致性从差到中等，ICC=0.09-0.46。最后，将关节线视图与AP和外侧视图相结合并无额外益处。
使用AP和外侧视图且移位5mm时，准确性、特异性和ICC最高。在这种情况之外，一致性从差到中等，准确性较低。在临床应用中，可能需要对关节面进行直视，以确保小于5mm的复位不良。
