Trauma Unit, Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands.
Trauma Unit, Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands.
Eur J Radiol. 2019 Mar;112:222-228. doi: 10.1016/j.ejrad.2019.01.013. Epub 2019 Jan 18.
The aim of this study was to determine the correlation of the intra-operative fluoroscopic 2D- and 3D-images compared with a postoperative CT-scan, in terms of quality of reduction and fixation of calcaneal fractures.
Patients requiring open reduction and internal fixation (ORIF) of a calcaneal fracture were recruited as part of the EF3X-trial. During surgery, intra-operative images of fluoroscopic 2D- and 3D-imaging were obtained to assess the quality of the reduction and implant position. All patients received a postoperative CT-scan within one week. The operating surgeon evaluated intra-operatively both 2D- and 3D-images according to a 23-item scoring protocol on a 3-point Likert scale. A scoring panel, consisting of three clinical experts, evaluated all images in a blinded and independent fashion. Intraclass correlation coefficients (ICC) with their 95% confidence intervals (CI) were calculated using a two-way-random model with absolute agreement.
A total of 102 calcaneal fractures were included. Agreement of 3D-imaging for the quality of reduction was better than 2D-imaging, although still fair, but for fixation moderate to good. Agreement between the 2D-images and the CT-scans was poor to fair. Intra-operative 2D-imaging received the highest ratings for image quality and interpretability, followed by CT-scanning.
Implant position can be evaluated satisfactory with the aid of intra-operative 3D imaging. Although intra-operative 3D imaging had a better agreement with postoperative CT-scanning than 2D-imaging, there is a need to improve image quality and suppress scattering from implants to improve the additional value of intra-operative 3D imaging in calcaneal fracture reduction and fixation.
本研究旨在确定术中二维和三维荧光透视图像与术后 CT 扫描在跟骨骨折复位和固定质量方面的相关性。
作为 EF3X 试验的一部分，招募需要切开复位内固定（ORIF）的跟骨骨折患者。在手术过程中，获得术中二维和三维荧光透视图像，以评估复位质量和植入物位置。所有患者在一周内接受术后 CT 扫描。手术医生根据 3 分李克特量表对 2D 和 3D 图像进行了 23 项评分协议的术中评估。由三名临床专家组成的评分小组以盲法和独立的方式评估所有图像。使用双向随机模型和绝对一致性计算具有 95%置信区间（CI）的组内相关系数（ICC）。
共纳入 102 例跟骨骨折。尽管 3D 成像的复位质量的一致性仍为中等至良好，但比 2D 成像好。对于固定，3D 成像的一致性比 2D 成像好，但比 CT 扫描差。2D 图像与 CT 扫描之间的一致性较差。术中 2D 成像的图像质量和可解释性评分最高，其次是 CT 扫描。
术中 3D 成像可满意评估植入物位置。尽管术中 3D 成像与术后 CT 扫描的一致性优于 2D 成像，但需要提高图像质量并抑制来自植入物的散射，以提高术中 3D 成像在跟骨骨折复位和固定中的附加价值。
