Hoogervorst Paul, Chopra Aman, Working Zachary M, El Naga Ashraf N, Verdonschot Nico, Hannink Gerjon
Department of Orthopaedics, Radboud University Medical Center, Nijmegen, The Netherlands.
Orthopaedic Trauma Institute, ZSFG/UCSF Department of Orthopaedic Surgery, San Francisco, CA, USA.
JSES Int. 2020 Feb 13;4(2):251-255. doi: 10.1016/j.jseint.2019.12.003. eCollection 2020 Jun.
Measured shortening of midshaft clavicle fracture fragments is known to be influenced by multiple factors. The influence of radiographic projection on vertical displacement is unclear. The aims of this study were (1) to quantify the difference in measurements of vertical displacement in an absolute, relative, and categorical manner between 5 different projections; (2) to quantify the differences in interobserver and intraobserver agreement using a standardized method for measuring vertical displacement; and (3) to assess the association between categorical and continuous descriptions of vertical displacement.
A clinical measurement study was conducted on 31 sets of digitally reconstructed radiographs in 5 different projections (15° and 30° caudocranial, anteroposterior, and 15° and 30° craniocaudal views). Categorical data on vertical displacement in quartiles from 0%-200% were obtained followed by measurements using a standardized method by 3 observers at 2 points in time. Interobserver and intraobserver agreement for each of the 5 views was calculated.
The absolute and relative vertical displacement showed no statistically significant difference between any of the caudocranial, anteroposterior, and craniocaudal views. Intraclass correlation coefficients for intraobserver and interobserver agreement were good to excellent. The correlation between categorical outcomes and both absolute and relative vertical displacement was very strong.
Unlike shortening, absolute and relative vertical displacement of the midshaft clavicle fracture is not significantly influenced by radiographic projection. Standardized measurements of vertical displacement may not be necessary for clinical use because the correlation between categorical and continuous measurements was found to be very strong.
已知锁骨中段骨折碎片的测量缩短受多种因素影响。影像学投照对垂直移位的影响尚不清楚。本研究的目的是：（1）以绝对、相对和分类方式量化5种不同投照下垂直移位测量值的差异；（2）使用标准化方法测量垂直移位，量化观察者间和观察者内一致性的差异；（3）评估垂直移位的分类描述与连续描述之间的关联。
对31组数字重建的X线片进行临床测量研究，X线片有5种不同投照（尾头向15°和30°、前后位、头尾向15°和30°视图）。获得垂直移位的四分位数分类数据，范围为0%-200%，随后由3名观察者在2个时间点使用标准化方法进行测量。计算5种视图中每种视图的观察者间和观察者内一致性。
在任何尾头向、前后位和头尾向视图之间，绝对和相对垂直移位均无统计学显著差异。观察者内和观察者间一致性的组内相关系数良好至优秀。分类结果与绝对和相对垂直移位之间的相关性非常强。
与缩短情况不同，锁骨中段骨折的绝对和相对垂直移位不受影像学投照的显著影响。由于发现分类测量与连续测量之间的相关性非常强，临床使用时可能无需对垂直移位进行标准化测量。
