Wieschollek Stefanie, Kalb Karl-Heinz, Christopoulos Georgios, Geue Roland, Schmitt Rainer, Prommersberger Karl-Josef
Rhön-Klinikum, Klinik für Handchirurgie.
Rhön-Klinikum, Klinik für Radiologie.
Handchir Mikrochir Plast Chir. 2018 Jun;50(3):169-173. doi: 10.1055/a-0645-6965. Epub 2018 Jul 25.
Because of its form, size and position, the scaphoid is known to be the foundation stone of the carpus, with an exceptionally important biomechanical function. Therefore evaluation of fracture morphology is essential. Experts already agree that computed tomography (CT scan) in the long axis of the scaphoid is the best approach for diagnosing scaphoid fractures, but also for therapy planning. But this method is hardly a standard in most hospitals and studies showing superiority of this technique for therapy planning are non-existent.
The purpose of this retrospective study was to test if the interobserver reliability for the evaluation of scaphoid fracture morphology in CT scans in the long axis of the scaphoid is greater than in CT scans in the plane of the wrist, and thus more reliable.
42 patients with scaphoid fractures had a CT scan in the long axis of the scaphoid (CT-scaphoid). CT reformations along planes relative to the wrist (CT -wrist) were made. Those 84 cases were anonymised and put in a random order. They were presented to 4 clinical observers (2 hand surgeons and 2 radiologists) for fracture evaluation with respect to: localisation, humpback deformity, offset (radial/ulnar and palmar/dorsal) and classification by Herbert. Surgeons have to select a palmar or dorsal approach as well as an open or percutaneous technique. Statistical analysis was made between 2 and 4 observers by an impartial statistician, using Cohen's kappa coefficient, Pearson coefficient, Fleiss' kappa, interclass correlation coefficient (Shrout and Fleiss) and Spearman rho coefficient.
In all evaluated parameters, the interobserver reliabilty was higher in the CT scan in the long axis of the scaphoid, although statistical significance was only found for the humpback deformity.
For evaluation and understanding scaphoid fractures, the CT scan along the long axis of the scaphoid is more significant and reliable than the scan in the plane of the wrist and is therefore preferable.
由于舟骨的形状、大小和位置，它被认为是腕骨的基石，具有极其重要的生物力学功能。因此，评估骨折形态至关重要。专家们已经达成共识，沿舟骨长轴进行计算机断层扫描（CT扫描）是诊断舟骨骨折以及制定治疗方案的最佳方法。但在大多数医院，这种方法几乎不是标准做法，且不存在显示该技术在治疗方案制定方面优越性的研究。
这项回顾性研究的目的是检验在评估舟骨长轴CT扫描中舟骨骨折形态时，观察者间的可靠性是否高于腕关节平面CT扫描，从而更可靠。
42例舟骨骨折患者接受了沿舟骨长轴的CT扫描（舟骨CT）。进行了相对于腕关节平面的CT重建（腕关节CT）。这84个病例被匿名处理并随机排序。将它们呈现给4名临床观察者（2名手外科医生和2名放射科医生），以评估骨折的以下方面：定位、驼背畸形、移位（桡侧/尺侧和掌侧/背侧）以及赫伯特分类。外科医生必须选择掌侧或背侧入路以及开放或经皮技术。由一名公正的统计学家对2至4名观察者之间的数据进行统计分析，使用科恩kappa系数、皮尔逊系数、弗莱iss kappa系数、组内相关系数（施鲁特和弗莱iss）以及斯皮尔曼rho系数。
在所有评估参数中，舟骨长轴CT扫描中观察者间的可靠性更高，尽管仅在驼背畸形方面发现了统计学意义。
对于评估和理解舟骨骨折，沿舟骨长轴的CT扫描比腕关节平面扫描更具意义且更可靠，因此更可取。
