Pirozzi Kelly M, Meyr Andrew J
Surgeon, Private Practice, Valley Foot Surgeons, Scottsdale, AZ.
Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
J Foot Ankle Surg. 2017 May-Jun;56(3):547-550. doi: 10.1053/j.jfas.2017.01.027. Epub 2017 Mar 3.
The clinical value of routine postoperative radiographic evaluation after orthopedic procedures has recently been called into question. The objective of the present investigation was to evaluate the ability of foot and ankle surgeons to accurately and reliably assess postoperative radiographs after first metatarsal-phalangeal joint arthrodesis. Thirty sets of digital radiographs from 11 patients who had undergone first metatarsal-phalangeal joint arthrodesis were retrospectively evaluated by 5 podiatric physicians board-certified in foot surgery. The surgeons were asked to answer several questions, including whether the radiograph appeared to be >4 or <4 postoperative weeks; whether the radiograph appeared to be >8 or <8 postoperative weeks; their estimation of the postoperative week; and whether they would allow the patient to begin weightbearing based on the radiographic findings. With respect to whether the radiographs were >4 or <4 postoperative weeks, surgeons made accurate assessments 63.33% of the time (95 of 150; range 56.67% to 73.33%), with a kappa of 0.220. With respect to whether the radiographs were >8 or <8 postoperative weeks, surgeons made accurate assessments 60.0% of the time (90 of 150; range 53.33% to 70.0%), with a kappa of 0.203. With respect to the estimation of the postoperative week of the radiograph, surgeons accurately assessed the radiographs within a 4-week period 34.0% of the time (54 of 150; range 26.67% to 46.67%), with a kappa of 0.425. With respect to allowing the patient to bear weight according to the radiographic findings, the surgeons were in complete agreement 26.67% of the time (8 of 30), with a kappa of 0.251. These results provide evidence against the serial routine use of postoperative radiographs for the first metatarsal-phalangeal joint arthrodesis in the absence of a specific clinical indication.
骨科手术后常规影像学评估的临床价值最近受到了质疑。本研究的目的是评估足踝外科医生准确、可靠地评估第一跖趾关节融合术后X线片的能力。5名获得足外科委员会认证的足病医生对11例接受第一跖趾关节融合术患者的30组数字X线片进行了回顾性评估。要求外科医生回答几个问题，包括X线片看起来是术后4周以上还是4周以下；X线片看起来是术后8周以上还是8周以下；他们对术后周数的估计；以及他们是否会根据X线片结果允许患者开始负重。关于X线片是术后4周以上还是4周以下，外科医生在63.33%的时间内做出了准确评估（150次中有95次；范围为56.67%至73.33%），kappa值为0.220。关于X线片是术后8周以上还是8周以下，外科医生在60.0%的时间内做出了准确评估（150次中有90次；范围为53.33%至70.0%），kappa值为0.203。关于对X线片术后周数的估计，外科医生在34.0%的时间内（150次中有54次；范围为26.67%至46.67%）在4周内准确评估了X线片，kappa值为0.425。关于根据X线片结果允许患者负重，外科医生在26.67%的时间内（30次中有8次）完全一致，kappa值为0.251。这些结果提供了证据，反对在没有特定临床指征的情况下对第一跖趾关节融合术进行术后X线片的系列常规使用。
