Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany; Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria.
Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany; Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria.
Arthroscopy. 2018 Feb;34(2):398-404. doi: 10.1016/j.arthro.2017.08.234. Epub 2017 Nov 2.
To analyze the effect of lack of standardization on the reliability of current measurement techniques for glenoid bone loss in clinical practice.
Ten consecutive patients with anterior glenoid bone loss due to recurrent anterior shoulder instability and available computed tomographic (CT) scans of the affected shoulder were included in this study. One hundred seventy 3-dimensional en-face view images of the 10 glenoids with up to 20° degrees of tilt in the anterior, posterior, superior, and inferior direction were rendered. Three independent observers first identified the en-face view images and subsequently performed measurements of the defect surface and diameter as well as the glenoid surface and diameter on all 170 images. Measurements were completed based on the conventional best-fit circle technique using the edge of the visible glenoid bone as reference and additionally based on the so-called spoon technique, which places the best-fit circle on the edge of the visible glenoid concavity.
The overall agreement regarding en-face view image selection between the observers was 30% (K-alpha = 0.10, 95% confidence interval 0.02-0.22). Tilt of the en-face view in any direction resulted in significant alterations of all 4 measurement parameters as well as the relative defect area and diameter (P < .05). The conventional and the spoon techniques rendered significantly different results regarding all 4 measurement parameters as well as the relative defect area (P < .05).
Impreciseness of scapula positioning for creation of an en-face view of the glenoid as well as varying best-fit circle placement significantly alter glenoid defect size measurement results.
Because the glenoid defect size plays an important role in the choice of treatment for anterior shoulder instability, measurement techniques need to be as precise as possible.
分析当前测量技术在临床实践中对肩胛盂骨丢失的可靠性缺乏标准化的影响。
本研究纳入了 10 例因复发性前肩不稳定而导致前肩胛盂骨丢失的连续患者，且这些患者均有其患肩的 CT 扫描图像。对 10 个肩胛盂进行了 170 个三维面视图图像渲染，这些肩胛盂在前后、上下方向的倾斜角度最大可达 20°。3 名独立观察者首先识别出面视图图像，然后对所有 170 个图像上的缺陷表面和直径以及肩胛盂表面和直径进行测量。测量是基于传统的最佳拟合圆技术完成的，该技术以可见肩胛盂骨的边缘为参考，并额外采用所谓的勺子技术，即将最佳拟合圆放在可见肩胛盂凹面的边缘上。
观察者对面视图图像选择的整体一致性为 30%（K-alpha=0.10，95%置信区间为 0.02-0.22）。面视图在任何方向的倾斜都会导致所有 4 个测量参数以及相对缺陷面积和直径发生显著变化（P<0.05）。传统技术和勺子技术在所有 4 个测量参数以及相对缺陷面积方面都产生了显著不同的结果（P<0.05）。
肩胛盂位置不准确对面视图的创建以及最佳拟合圆的放置会显著改变肩胛盂缺陷大小的测量结果。
由于肩胛盂缺陷大小在选择前肩不稳定的治疗方法中起着重要作用，因此测量技术需要尽可能精确。
