术前骨扫描评估初次全膝关节置换翻修术的假体松动价值如何？
What Is the Value of Component Loosening Assessment of a Preoperatively Obtained Bone Scan Prior to Revision Total Knee Arthroplasty?
机构信息
Orthopedic Surgeon, Duke University, Durham, NC.
Orthopedic Surgeon, Illinois Bone and Joint Institue, Barrington, IL.
出版信息
J Arthroplasty. 2019 Jul;34(7S):S256-S261. doi: 10.1016/j.arth.2019.02.065. Epub 2019 Mar 29.
BACKGROUND
Bone scintigraphy (BS) is frequently ordered to investigate cause of failure following total knee arthroplasty (TKA). Its correlation of component loosening with intraoperative findings (IFs) at the time of revision TKA (rTKA) has not been well studied. This study investigated correlations between the preoperatively obtained radiologist report (RR) of BS, preoperatively documented surgeon prediction (SP) of component loosening, and operative reports documenting IFs.
METHODS
Our institutional database was retrospectively reviewed for all rTKA done after BS and revealed 96 eligible cases. The RR and SP cohorts were subdivided into all potential combinations of component loosening and were then compared with each other as well as IF. In addition to calculating the percentage correct of RR and SP compared with IF, the levels of agreement between RR and SP were compared using the kappa statistic.
RESULTS
Of the 96 cases, the RR correctly correlated with IF in 35 cases (37%), whereas the SP was correct in 66 cases (69%), indicating the preoperative interpretation of the surgeon regarding component loosening at rTKA was correct more frequently (P < .001). The kappa statistic between RR and IF was only 0.23 (95% confidence interval [CI] = 0.15-0.32), indicating minimal agreement. The kappa statistic between SP and IF was 0.57 (95% = CI 0.46-0.68), indicating weak agreement. Furthermore, the kappa statistic between RR and SP was 0.36 (95% CI = 0.27-0.45), also indicating minimal agreement.
CONCLUSIONS
In rTKA, there is weak agreement regarding component loosening between a radiologist's opinion of a preoperatively obtained bone scan and the surgeon's preoperative interpretation of clinical and radiographic data. While neither reliably accurately predicts what is found at the time of rTKA, the surgeon's preoperative interpretation is more closely correlated with actual IFs of component loosening.
背景
全膝关节置换术（TKA）后，常进行骨闪烁扫描（BS）以明确失败原因。但 BS 与翻修 TKA（rTKA）时术中所见（IF）的相关性尚未得到充分研究。本研究旨在探讨术前放射科医生 BS 报告（RR）、术前医生对假体松动的预测（SP）与术中 IF 之间的相关性。
方法
我们回顾性分析了所有接受 BS 检查后行 rTKA 的患者的病历资料，共纳入 96 例患者。RR 和 SP 队列根据假体松动的所有潜在组合进行细分，然后将它们与 IF 进行比较。除了计算 RR 和 SP 与 IF 相符的百分比外，还使用 Kappa 统计来比较 RR 和 SP 之间的一致性水平。
结果
96 例患者中，RR 与 IF 相符的有 35 例（37%），而 SP 与 IF 相符的有 66 例（69%），提示术前医生对 rTKA 时假体松动的解读更为准确（P＜0.001）。RR 与 IF 之间的 Kappa 统计值仅为 0.23（95%CI=0.15-0.32），提示一致性较低。SP 与 IF 之间的 Kappa 统计值为 0.57（95%CI=0.46-0.68），提示一致性较弱。此外，RR 与 SP 之间的 Kappa 统计值为 0.36（95%CI=0.27-0.45），也提示一致性较低。
结论
在 rTKA 中，放射科医生对术前骨扫描的意见与医生对临床和影像学数据的术前解读在假体松动方面的一致性较弱。虽然两者都不能可靠地准确预测 rTKA 时的发现，但医生的术前解读与实际的 IF 更为相关。
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