使用骨盆畸形测量软件程序对骨盆骨折进行放射学测量。

Radiological measurement of pelvic fractures using a pelvic deformity measurement software program.

机构信息

Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Rd. Haidian District, Beijing, 100853, People's Republic of China.

出版信息

J Orthop Surg Res. 2020 Jan 31;15(1):37. doi: 10.1186/s13018-020-1558-2.

DOI:10.1186/s13018-020-1558-2

PMID:32005205

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6995216/

Abstract

BACKGROUND

It is difficult for the surgeon to measure pelvic displacement in the closed reduction operation for unstable pelvic fracture. We therefore developed a pelvic deformity measurement software program based on standardized radiographs. The objectives of the present study were to evaluate the inter-observer reliability of the program for measuring specific fracture types on preoperative pelvic films and to assess the validity of the measurement software program by comparing it with a gold standard.

METHODS

Twenty-five patients diagnosed with AO/OTA type B or C pelvic fractures with the unilateral pelvis fractured and dislocated were included in this study. Four separate observers repeatedly determined the translational and rotational patterns and outcomes using the software program and hand measurement, and calculated the displacement using computed tomography (CT) coupled with a three-dimensional (3D) CT model. The validity of the measurement software was calculated by assessing the consistency between the software measurements and the gold standard. Additionally, inter-observer reliability was assessed for the software. The software was also applied in preliminary clinical practice for closed reduction procedures.

RESULTS

The overall inter-observer reliabilities of the software program, CT coupled with 3D reconstruction, and hand measurements were high, with kappa values of 0.956, 0.958, and 0.853, respectively. The software showed validity similar to that of CT coupled with 3D reconstruction (0.939 vs. 0.969), and better than that of hand measurement (0.939 vs. 0.858). A preliminary clinical application demonstrated that the software is effective for guiding closed reduction of pelvic fractures.

CONCLUSIONS

Our newly established pelvic deformity measurement program is a reliable and accurate tool for analyzing pelvic displacement patterns and can be used for guidance of closed reduction and planning of the reduction pathway.

LEVEL OF EVIDENCE

III.

摘要

背景

在不稳定骨盆骨折的闭合复位手术中，外科医生很难测量骨盆的移位情况。因此，我们开发了一种基于标准化 X 线片的骨盆畸形测量软件程序。本研究的目的是评估该程序在术前骨盆 X 线片上测量特定骨折类型的观察者间可靠性，并通过与金标准比较来评估测量软件程序的有效性。

方法

本研究纳入了 25 例诊断为 AO/OTA 型 B 或 C 型骨盆骨折且单侧骨盆骨折脱位的患者。4 名独立观察者分别使用软件程序和手工测量多次确定平移和旋转模式及结果，并通过 CT 与三维（3D）CT 模型结合计算移位。通过评估软件测量值与金标准之间的一致性来计算测量软件的有效性。此外，还评估了软件的观察者间可靠性。该软件还初步应用于闭合复位手术。

结果

软件程序、CT 与 3D 重建和手工测量的整体观察者间可靠性均较高，kappa 值分别为 0.956、0.958 和 0.853。软件的有效性与 CT 与 3D 重建相似（0.939 与 0.969），优于手工测量（0.939 与 0.858）。初步临床应用表明，该软件可有效指导骨盆骨折的闭合复位。