Ten Berg Paul W L, Drijkoningen Tessa, Guitton Thierry G, Ring David
1 University of Amsterdam, The Netherlands.
2 Harvard Medical School, Boston, MA, USA.
Hand (N Y). 2017 Sep;12(5):439-445. doi: 10.1177/1558944716677541. Epub 2016 Nov 10.
Radiological grading of wrist osteoarthritis associated with scaphoid nonunion advanced collapse (SNAC) can be difficult. A comparison radiograph of the contralateral healthy wrist and an educational training in the various SNAC stages may improve reliability. Our purposes were to evaluate the difference in the reliability: (1) between observers who rate SNAC wrists with and without a comparison radiograph; and (2) between observers who receive training prior to ratings and those who do not.
In this cross-sectional survey study, 82 fully trained orthopedic or hand surgeons rated anteroposterior radiographs of 19 patient wrists following a scaphoid nonunion based on SNAC stages 0 to 4. Observers were randomized online in 4 groups: one group rated unilateral views without training, a second group unilateral views with training, a third group bilateral views without training, and a fourth group bilateral views with training. Training included a 1-page clarification of the SNAC stages. Interobserver agreement was calculated using kappa statistics.
There was no significant difference between agreement between observers who rated unilateral radiographs (κ = 0.55) and who rated bilateral radiographs (κ = 0.58) ( P = .14), nor between agreement between observers who received training (κ = 0.59) and who did not (κ = 0.54) ( P = .058).
The use of an additional comparison view and/or training does not seem to be clinically relevant in SNAC staging. There is room for improvement in the way we assess patients with SNAC wrists.
与舟骨不愈合伴晚期塌陷（SNAC）相关的腕关节骨关节炎的放射学分级可能具有挑战性。对侧健康腕关节的对比X线片以及对SNAC各阶段的教育培训可能会提高分级的可靠性。我们的目的是评估以下方面可靠性的差异：（1）对有和没有对比X线片的SNAC腕关节进行分级的观察者之间；（2）在分级前接受培训的观察者和未接受培训的观察者之间。
在这项横断面调查研究中，82名训练有素的骨科或手外科医生根据SNAC 0至4期对19例舟骨不愈合患者的腕关节前后位X线片进行分级。观察者通过网络随机分为4组：一组在未接受培训的情况下对单侧X线片进行分级，第二组在接受培训的情况下对单侧X线片进行分级，第三组在未接受培训的情况下对双侧X线片进行分级，第四组在接受培训的情况下对双侧X线片进行分级。培训内容包括1页关于SNAC各阶段的说明。使用kappa统计量计算观察者间的一致性。
对单侧X线片进行分级的观察者之间的一致性（κ = 0.55）与对双侧X线片进行分级的观察者之间的一致性（κ = 0.58）无显著差异（P = 0.14），接受培训的观察者之间的一致性（κ = 0.59）与未接受培训的观察者之间的一致性（κ = 0.54）也无显著差异（P = 0.058）。
在SNAC分期中，使用额外的对比视图和/或培训在临床上似乎并无关联。我们评估SNAC腕关节患者的方式仍有改进空间。
