在拇外翻决策中，非负重位与负重位 X 射线比较。
Non-weightbearing compared with weightbearing x-rays in hallux valgus decision-making.
机构信息
Department of Traumatology and Orthopaedics, Centre of Postgraduate Medical Education, Professor Adam Gruca Clinical Hospital, Konarskiego Str. 13, 05-400, Otwock, Poland.
Department of Orthopedics and Rehabilitation, University Hospital in Krakow, Krakow, Poland.
出版信息
Skeletal Radiol. 2020 Sep;49(9):1441-1447. doi: 10.1007/s00256-020-03441-9. Epub 2020 Apr 21.
OBJECTIVE
To report the effect of weightbearing x-ray imaging on clinical decisions in hallux valgus. Weightbearing (WB) x-ray is standard imaging for symptomatic hallux valgus (HV). In our clinical practice, often patients are presenting with non-weightbearing (NWB) x-rays. Repeated imaging requires additional radiation, justified only if expected to benefit patient's treatment. In this study, the influence of WB status on radiological HV parameters and on clinical decisions was analyzed.
METHODS
In the dataset of WB and NWB x-rays, the hallux valgus (HVA) and intermetatarsal angle (IMA) were measured and differences analyzed. Clinical decisions for 10 x-ray pairs were studied among 40 respondents.
RESULTS
The WB and NWB HVA difference ranged - 16 to 16° (p < 0.001) and IMA - 3.4 to 5.8° (p < 0.001). In only 45% of cases, the decisions based on NWB and WB imaging were consistent (kappa (95% CI) = 30.0 (23.7-36.3)).
CONCLUSIONS
Clinical decisions based on WB and NWB radiographs vary significantly. NWB films overestimate early and underestimate advanced HV deformity. Repeating radiographs is justified in patients presenting with NWB radiographs of symptomatic HV.
目的
报告负重 X 线成像对拇外翻临床决策的影响。负重（WB）X 线是拇外翻（HV）症状的标准影像学检查。在我们的临床实践中，经常有患者出现非负重（NWB）X 线。重复成像需要额外的辐射，如果预期对患者的治疗有益，则是合理的。本研究分析了 WB 状态对放射 HV 参数和临床决策的影响。
方法
在 WB 和 NWB X 射线的数据集，测量了拇外翻（HVA）和跖骨间角（IMA）并分析了差异。对 40 名受访者的 10 对 X 射线对的临床决策进行了研究。
结果
WB 和 NWB HVA 差值范围为-16 至 16°（p<0.001），IMA 差值范围为-3.4 至 5.8°（p<0.001）。仅在 45%的情况下，基于 NWB 和 WB 成像的决策是一致的（kappa（95%CI）=30.0（23.7-36.3））。
结论
基于 WB 和 NWB 射线照片的临床决策差异很大。NWB 胶片会高估早期和低估晚期 HV 畸形。对于出现 NWB 有症状 HV 射线照片的患者，重复射线照片是合理的。
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