Agyeman Kofi D, DeVito Paul, McNeely Emmanuel, Malarkey Andy, Bercik Michael J, Levy Jonathan C
Miller School of Medicine, University of Miami, Miami, Florida.
Holy Cross Orthopedic Institute, Fort Lauderdale, Florida.
JB JS Open Access. 2020 Jan 6;5(1):e0049. doi: 10.2106/JBJS.OA.19.00049. eCollection 2020 Jan-Mar.
Axillary radiographs traditionally have been considered sufficient to identify concentric glenoid wear in osteoarthritic shoulders; however, with variable glenoid wear patterns, assessment with use of computed tomography (CT) has been recommended. The purpose of the present study was to compare the use of axillary radiographs and mid-glenoid axial CT scans to identify glenoid wear.
Preoperative axillary radiographs and mid-glenoid axial CT scans for 330 patients who underwent anatomic total shoulder arthroplasty were reviewed. Five independent examiners with differing levels of experience characterized the glenoid morphology as either concentric or eccentric. The morphologies determined with use of axillary radiographs and CT scans were assessed for correlation, and both intraobserver and interobserver consistency were calculated.
Concentric wear identified with use of radiographs was confirmed with use of CT scans in an average of 61% of cases (range, 53% to 76%). Intraobserver consistency averaged 75% for radiographs and 73% for CT scans. There was significant interobserver consistency, as higher levels of training corresponded with greater consistency between imaging analyses (p < 0.001). The most senior observer identified the highest proportion of concentric wear on radiographs (p < 0.001), showed the greatest consistency between attempts when using CT (p < 0.001), and had the greatest agreement of radiographs and CT evaluating glenoid morphology (p < 0.001).
For the experienced shoulder surgeon, concentric glenoid wear identified on axillary radiographs will appear concentric on 2-dimensional CT in approximately 75% of cases. Obtaining a CT scan to confirm glenoid wear patterns most greatly benefits less-experienced surgeons. Across all levels of experience, axillary radiographs and single-slice, mid-glenoid CT scans appear insufficient for consistently predicting wear patterns.
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
传统上认为腋位X线片足以识别骨关节炎性肩关节的同心圆状关节盂磨损；然而，鉴于关节盂磨损模式的多样性，推荐使用计算机断层扫描（CT）进行评估。本研究的目的是比较腋位X线片和关节盂中部轴向CT扫描在识别关节盂磨损方面的应用。
回顾了330例行解剖型全肩关节置换术患者的术前腋位X线片和关节盂中部轴向CT扫描。五名经验水平不同的独立检查者将关节盂形态特征化为同心圆状或偏心状。评估通过腋位X线片和CT扫描确定的形态之间的相关性，并计算观察者内和观察者间的一致性。
通过X线片确定的同心圆状磨损在平均61%的病例中（范围为53%至76%）经CT扫描得到证实。观察者内一致性在X线片方面平均为75%，在CT扫描方面平均为73%。存在显著的观察者间一致性，因为更高的培训水平与成像分析之间更大的一致性相关（p < 0.001）。最资深的观察者在X线片上识别出的同心圆状磨损比例最高（p < 0.001），在使用CT时不同检查之间的一致性最大（p < 0.001），并且在X线片和CT评估关节盂形态方面的一致性最大（p < 0.001）。
对于有经验的肩关节外科医生，腋位X线片上识别出的同心圆状关节盂磨损在二维CT上约75%的病例中会表现为同心圆状。获取CT扫描以确认关节盂磨损模式对经验较少的外科医生最有益。在所有经验水平中，腋位X线片和关节盂中部单层CT扫描似乎不足以持续预测磨损模式。
诊断性III级。有关证据水平的完整描述，请参阅作者指南。
