Ooka Nelson Hiroyuki Miyabe, Campos André Luiz Siqueira, da Fonseca Vitor Mudesto, Rodrigues Luis Edmundo Oliveira, Filho Edmilson Barbosa, Franco José Sérgio, E Albuquerque Rodrigo Satamini Pires, Gameiro Vinicius Schott
Knee Surgery Group, Orthopaedic Department, Hospital Federal dos Servidores do Estado do Rio de Janeiro (HFSE-RJ), Rio de Janeiro, Brazil.
Orthopaedics Department, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
Int Orthop. 2018 Jun;42(6):1275-1282. doi: 10.1007/s00264-018-3764-7. Epub 2018 Jan 15.
The purpose of this study was to evaluate the accuracy and reliability of pre-operative templating in predicting the size of femoral and tibial components and the effect of coronal deformity on templating accuracy.
This was a retrospective study of 39 pre-operative templates prepared by three different surgeons with different levels of training. The accuracy and reliability measures were evaluated by alpha and kappa coefficients of agreement. The analysis of the effect of coronal deformity on the accuracy of the template was measured by the Spearman's correlation test.
Templating was accurate for the femoral component in 28.21% of anterposterior (AP) radiographs and 35.90% of lateral radiographs. Kappa coefficients were respectively 0.111 (95% confidence interval [95%CI]: -0.19 to 0.241) and 0.200 (95%CI: -0.010 to 0.401), indicating poor agreement. Templating accuracy for the tibial component were, respectively, 37.61% and 47.01% for AP and lateral views. Kappa coefficients were 0.186 (95%CI: -0.070 to 0.379) for the AP view and 0.315 (95%CI: -0.199 to 0.431) for the lateral view, showing poor and slight agreement respectively. Considering a margin of error of ±1 sizes, the agreement level improved for all components, particularly for tibia, where agreement levels become very good. The inter-observer agreement was fair for all components, except for the lateral view of the femoral component, whose agreement was good. The Spearman correlation test showed no correlation between accuracy of templating and coronal deformity.
Pre-operative templating is an unreliable and inaccurate tool. There is no relation between coronal deformity and accuracy of templating.
本研究旨在评估术前模板在预测股骨和胫骨假体尺寸方面的准确性和可靠性，以及冠状面畸形对模板准确性的影响。
这是一项回顾性研究，研究对象为三位不同培训水平的外科医生所制备的39份术前模板。通过一致性的α系数和kappa系数评估准确性和可靠性指标。通过Spearman相关性检验分析冠状面畸形对模板准确性的影响。
在前后位（AP）X线片中，28.21%的股骨假体模板测量准确；在侧位X线片中，35.90%的股骨假体模板测量准确。kappa系数分别为0.111（95%置信区间[95%CI]：-0.19至0.241）和0.200（95%CI：-0.010至0.401），表明一致性较差。AP位和侧位胫骨假体模板测量的准确率分别为37.61%和47.01%。AP位视图的kappa系数为0.186（95%CI：-0.070至0.379），侧位视图的kappa系数为0.315（95%CI：-0.199至0.431），分别显示一致性较差和稍差。考虑到±1个尺寸的误差范围，所有假体的一致性水平均有所提高，尤其是胫骨，其一致性水平变得非常好。除股骨假体侧位视图的观察者间一致性良好外，所有假体的观察者间一致性均为中等。Spearman相关性检验显示模板准确性与冠状面畸形之间无相关性。
术前模板是一种不可靠且不准确的工具。冠状面畸形与模板准确性之间没有关系。
