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评估关节镜下证实的 TFCC 撕裂的儿童和青少年桡尺远侧关节的放射影像学不稳定征象。

Evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified TFCC tears.

机构信息

Department of Pediatric Orthopaedics and Foot and Ankle Surgery, Orthopedic Hospital Speising, Medical University Vienna, Speisingerstrasse 109, 1130, Vienna, Austria.

II. Orthopedic Department, Herz-Jesu Hospital, Vienna, Austria.

出版信息

Arch Orthop Trauma Surg. 2020 Jul;140(7):993-999. doi: 10.1007/s00402-020-03470-y. Epub 2020 May 7.

Abstract

INTRODUCTION

Recent reports in the adult literature reported the use of standardized radiographic measurement techniques to determine distal radioulnar joint (DRUJ) instability. The aim of this study was to evaluate the efficacy and accuracy of (1) the MRI-based modified radioulnar ratio technique and (2) the pisoscaphoid (PiSca) and radioulnar (RaUl) distances in true lateral radiographs in children and adolescents with arthroscopically-verified TFCC tears.

MATERIALS AND METHODS

We retrospectively assessed lateral wrist radiographs and axial MRI sequences of 18 adolescent patients (22 wrists) who had arthroscopically-confirmed TFCC tears and compared them to similar imaging of a control group of 28 healthy patients (28 wrists). Three raters assessed the images twice in a 2-week interval. Intraclass correlation coefficients (ICCs), unifactorial ANOVA, and ROC analysis were performed with regards to the different radiographic variables.

RESULTS

The interrater ICCs were almost perfect for all measurements except RaUl1, which showed a substantial agreement (0.751) among the three observers. The intrarater ICCs were almost perfect when measuring PiSca and MRI, and substantial to almost perfect for RaUl. Pearson's correlation showed a moderate, positive correlation between PiSca and RaUl distances (r = 0.608; p < 0.001), and a moderate, negative correlation between RaUl distance and MRI shift (r = - 0.486; p = 0.010). When the three core groups (peripheral, central tear, controls) were compared to each other regarding the radiographic instability parameters, only the MRI shift revealed a statistically significant difference (p = 0.003). Comparisons revealed significant differences between patients and controls (p = 0.004) and peripheral tears vs. controls (p = 0.001 and p = 0.010). The ROC analysis revealed a significant AUC only for the MRI (AuC 0.787 and p = 0.002).

CONCLUSIONS

Children and adolescents with peripheral TFCC tears showed significantly increased instability parameters in MRI compared to controls. These measurement techniques are no replacement for a thorough clinical examination but may be helpful for indicating diagnostic wrist arthroscopy in ambiguous cases.

LEVEL OF EVIDENCE

Level III; Diagnostic.

摘要

简介

最近有成人文献报道使用标准化的影像学测量技术来确定远侧桡尺关节(DRUJ)不稳定。本研究的目的是评估(1)基于 MRI 的改良桡尺比技术和(2)腕关节侧位片上的舟月骨(PiSca)和桡尺(RaUl)距离在经关节镜证实的 TFCC 撕裂的儿童和青少年中的疗效和准确性。

材料和方法

我们回顾性评估了 18 例经关节镜证实为 TFCC 撕裂的青少年患者(22 腕)的侧腕关节 X 线片和轴向 MRI 序列,并与 28 例健康患者(28 腕)的相似影像学资料进行比较。3 位评估者在 2 周间隔内对图像进行了两次评估。对不同影像学变量进行了组内相关系数(ICC)、单因素方差分析和 ROC 分析。

结果

除 RaUl1 外,所有测量的组内相关系数(ICC)均为近乎完美,而 RaUl1 则表现出高度一致(0.751)。测量 PiSca 和 MRI 时,组内 ICC 近乎完美,而 RaUl 则为高度一致至近乎完美。Pearson 相关分析显示 PiSca 和 RaUl 距离之间存在中度正相关(r=0.608;p<0.001),RaUl 距离与 MRI 移位之间存在中度负相关(r=-0.486;p=0.010)。当将三个核心组(外周、中央撕裂、对照组)彼此进行比较时,只有 MRI 移位显示出统计学差异(p=0.003)。与对照组相比,患者之间存在显著差异(p=0.004),外周撕裂与对照组相比也存在显著差异(p=0.001 和 p=0.010)。ROC 分析仅显示 MRI 有显著的 AUC(AuC 0.787,p=0.002)。

结论

与对照组相比,外周 TFCC 撕裂的儿童和青少年在 MRI 上显示出明显增加的不稳定参数。这些测量技术不能替代全面的临床检查,但在可疑病例中可能有助于指示诊断性腕关节镜检查。

证据水平

III 级;诊断性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4a67/7295725/df80dfc1301e/402_2020_3470_Fig1_HTML.jpg

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