iULS (Institut Universitaire Locomoteur & du Sport), Hôpital Pasteur 2, University of Nice Sophia-Antipolis, Nice, France.
Department of Orthopaedic Surgery, Centre Hospitalier Intercommunal de Cornouaille, Quimper, France.
J Bone Joint Surg Am. 2018 Jan 3;100(1):57-65. doi: 10.2106/JBJS.16.01122.
Preoperative computed tomography (CT) measurements of glenoid version and inclination are recommended for planning glenoid implantation in shoulder arthroplasty. However, current manual or semi-automated 2-dimensional (2D) and 3-dimensional (3D) methods are user-dependent and time-consuming. We assessed whether the use of a 3D automated method is accurate and reliable to measure glenoid version and inclination in osteoarthritic shoulders.
CT scans of osteoarthritic shoulders of 60 patients scheduled for shoulder arthroplasty were obtained. Automated, surgeon-operated, image analysis software (Glenosys; Imascap) was developed to measure glenoid version and inclination. The anatomic scapular reference planes were defined as the mean of the peripheral points of the scapular body as well as the plane perpendicular to it, passing along the supraspinatus fossa line. Measurements were compared with those obtained using previously described manual or semi-automated methods, including the Friedman version angle on 2D CTs, Friedman method on 3D multiplanar reconstructions (corrected Friedman method), Ganapathi-Iannotti and Lewis-Armstrong methods on 3D volumetric reconstructions (for glenoid version), and Maurer method (for glenoid inclination).The mean differences (and standard deviation) and the concordance correlation coefficients (CCCs) were calculated. Two orthopaedic surgeons independently examined the images for the interobserver analysis, with one of them measuring them twice more for the intraobserver analysis; interobserver and intraobserver reliability was calculated using the intraclass correlation coefficients (ICCs).
The mean difference in the Glenosys glenoid version measurement was 2.0° ± 4.5° (CCC = 0.93) compared with the Friedman method, 2.5° ± 3.2° (CCC = 0.95) compared with the corrected Friedman method, 1.5° ± 4.5° (CCC = 0.94) compared with the Ganapathi-Iannotti method, and 1.8° ± 3.8° (CCC = 0.95) compared with the Lewis-Armstrong method. There was a mean difference of 0.2° ± 4.7° (CCC = 0.78) between the inclination measurements made with the Glenosys and Maurer methods. The difference between the overall average 2D and 3D measurements was not significant (p = 0.45).
Use of fully automated software for 3D measurement of glenoid version and inclination in arthritic shoulders is reliable and accurate, showing excellent correlation with previously described manual or semi-automated methods.
The use of automated surgeon-operated image analysis software to evaluate 3D glenoid anatomy eliminates interobserver and intraobserver discrepancies, improves the accuracy of preoperative planning for shoulder replacement, and offers a potential gain of time for the surgeon.
术前 CT 测量肩盂的版本和倾斜度，有助于规划肩盂置换术中的肩盂植入。然而，目前手动或半自动的二维（2D）和三维（3D）方法依赖于使用者，并且耗时。我们评估了使用 3D 自动化方法测量骨关节炎肩盂的版本和倾斜度是否准确可靠。
对 60 例拟行肩关节炎置换术的骨关节炎肩 CT 扫描进行了测量。开发了自动、手术者操作的图像分析软件（Glenosys；Imascap）来测量肩盂的版本和倾斜度。解剖肩胛参考平面定义为肩胛体的外周点的平均值以及与其垂直的平面，沿肩胛上窝线通过。测量结果与先前描述的手动或半自动方法进行了比较，包括 2D CT 上的 Friedman 版本角、3D 多平面重建上的 Friedman 法（校正 Friedman 法）、3D 容积重建上的 Ganapathi-Iannotti 和 Lewis-Armstrong 法（用于肩盂版本）和 Maurer 法（用于肩盂倾斜度）。计算平均差异（和标准差）和一致性相关系数（CCCs）。两名骨科医生独立检查图像进行观察者间分析，其中一名医生进行了两次观察者内分析；观察者内和观察者间可靠性使用组内相关系数（ICCs）进行计算。
与 Friedman 法相比，Glenosys 肩盂版本测量的平均差异为 2.0°±4.5°（CCC=0.93），与校正 Friedman 法相比为 2.5°±3.2°（CCC=0.95），与 Ganapathi-Iannotti 法相比为 1.5°±4.5°（CCC=0.94），与 Lewis-Armstrong 法相比为 1.8°±3.8°（CCC=0.95）。Glenosys 和 Maurer 方法测量的倾斜度之间的平均差异为 0.2°±4.7°（CCC=0.78）。总体平均 2D 和 3D 测量值之间的差异无统计学意义（p=0.45）。
使用完全自动化的软件进行骨关节炎肩盂的 3D 测量版本和倾斜度是可靠和准确的，与以前描述的手动或半自动方法具有极好的相关性。
使用自动手术者操作的图像分析软件来评估 3D 肩盂解剖结构，可以消除观察者间和观察者内的差异，提高肩部置换术的术前规划准确性，并为外科医生节省潜在的时间。
