Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A..
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A.
Arthroscopy. 2020 Jan;36(1):12-19. doi: 10.1016/j.arthro.2019.06.025.
To determine, in the context of measuring bone loss in shoulder instability, whether measurement differences between magnetic resonance imaging (MRI) and computed tomography (CT), linear-based and area-based methods, and observers altered the proposed treatment when a standardized algorithm was applied.
This was a retrospective, comparative imaging study of preoperative patients with anterior shoulder instability with both an MRI and CT scan within 1 year of one another. On parasagittal images reoriented en face to the glenoid, 2 attending orthopaedic surgeons measured glenoid width, glenoid area, glenoid defect width, and glenoid defect area. On axial images maximal Hill-Sachs width was measured. From these, linear percent glenoid bone loss (%GBL) and area %GBL were calculated, and on-versus off-track was determined. With these results, a recommended treatment was determined by applying a standardized algorithm, in which the Latarjet procedure was selected for %GBL >20%, arthroscopic labral repair and remplissage for off-track lesions with %GBL <20%, and arthroscopic labral repair on-track shoulders with %GBL <20%.
In total, 53 patients with mean ± standard deviation 45 ± 83 days between scans were include with a CT linear %GBL of 23.5 ± 9.6% (range 0%-47%). CT lead to larger measurements of %GBL than MRI (linear P = .008, area P = .003), and fewer shoulders being considered on-track (33.0% vs 40.5%), which would alter treatment in 25% to 34%. Linear measurements produced larger values for %GBL (CT, P < .001; MRI, P < .001), which would alter treatment in 25%. For %GBL, inter-rater reliability was good, with intraclass correlation coefficients varying from 0.727 to 0.832 and Kappa varying from 0.57 to 0.62, but these inter-rater differences would alter treatment in 31%.
The significant differences in bone loss measurement between imaging modality, measurement method, and observers may lead to differences in treatment in up to 34% of cases. Linear CT measurements resulted in the most aggressive treatment recommendations.
Retrospective Comparative Study: Diagnostic, Level III.
在测量肩关节不稳定的骨丢失的情况下，确定磁共振成像（MRI）和计算机断层扫描（CT）、基于线性和基于面积的方法以及观察者之间的测量差异是否会在应用标准化算法时改变建议的治疗方案。
这是一项回顾性、比较影像学研究，纳入了 53 例同侧肩关节前不稳定患者，在 1 年内分别接受了 MRI 和 CT 扫描。在重新定向为面向关节盂的矢状位图像上，2 位主治骨科医生测量了关节盂宽度、关节盂面积、关节盂缺损宽度和关节盂缺损面积。在轴位图像上测量了最大 Hill-Sachs 宽度。根据这些结果，计算了线性百分比关节盂骨丢失（%GBL）和面积%GBL，并确定了是否在轨道上。根据这些结果，通过应用标准化算法确定了推荐的治疗方案，其中对于%GBL>20%的患者选择 Latarjet 手术，对于%GBL<20%的脱轨病变患者选择关节镜下盂唇修复和填塞术，对于%GBL<20%的关节镜下盂唇修复在轨道上的肩。
平均（标准差）45±83 天的 53 例患者纳入研究，CT 线性%GBL 为 23.5±9.6%（范围 0%-47%）。CT 导致的%GBL 测量值大于 MRI（线性 P=0.008，面积 P=0.003），并且认为更少的肩在轨道上（33.0%对 40.5%），这将改变 25%至 34%的治疗方案。线性测量产生的%GBL 值更大（CT，P<0.001；MRI，P<0.001），这将改变 25%的治疗方案。对于%GBL，观察者之间的可靠性良好，组内相关系数在 0.727 到 0.832 之间，Kappa 值在 0.57 到 0.62 之间，但这些观察者之间的差异会改变 31%的治疗方案。
成像方式、测量方法和观察者之间的骨丢失测量差异可能导致多达 34%的病例治疗方案的差异。线性 CT 测量结果导致了最激进的治疗建议。
回顾性比较研究：诊断，III 级。
