超声对伴有桡骨远端骨折的舟月骨间韧带损伤的分类。
Ultrasonographic Classification of Scapholunate Interosseous Ligament Injury Associated With Distal Radius Fracture.
机构信息
Department of Orthopaedic Surgery, JR Tokyo General Hospital, Tokyo, Japan.
Department of Orthopaedic Surgery, JR Tokyo General Hospital, Tokyo, Japan.
出版信息
J Hand Surg Am. 2020 Dec;45(12):1182.e1-1182.e5. doi: 10.1016/j.jhsa.2020.05.021. Epub 2020 Jul 18.
PURPOSE
Although scapholunate interosseous ligament (SLIL) injury is often associated with distal radius fracture, it is frequently missed in x-rays. The purpose of this study was to develop a diagnostic classification based on ultrasonography for SLIL injury and evaluate its diagnostic accuracy.
METHODS
Patients who required surgery for distal radius fracture were included in this study. Ultrasonography and arthroscopy were performed in all patients. The original ultrasonography-based classification of the dorsal part of SLIL was developed as follows: for type A, the SLIL surface was outlined clearly as a continuous flat line; for type B, the SLIL surface was outlined clearly as a continuous bulged line; and for type C, the SLIL surface was not continuous, smooth, or outlined clearly. Arthroscopy was performed at the time of osteosynthesis. We classified its findings according to the arthroscopic classification system of Geissler et al and evaluated interobserver and intraobserver reliabilities for our classification on ultrasonography. We also studied the relationship between the ultrasonographic and arthroscopic classifications.
RESULTS
In total, 40 patients were included in this study. Weighted κ values for interobserver and intraobserver reliabilities for our ultrasonographic classification were 0.83 (95% confidence interval, 0.70-0.96) and 0.88 (95% confidence interval, 0.77-0.99), respectively. There were 17 patients with type A, 14 with type B, and 9 with type C on ultrasonography. Ultrasonography had a sensitivity of 64% and specificity of 93% for the assumption that type C on ultrasonography corresponded to Geissler grades 3 and 4 on arthroscopy. No patient with type A on ultrasonography was classified as Geissler grades 3 and 4 on arthroscopy.
CONCLUSIONS
We concluded that ultrasonography has a high specificity but low sensitivity for the diagnosis of SLIL injury.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic Ⅱ.
目的
虽然舟月骨间韧带（SLIL）损伤通常与桡骨远端骨折有关，但在 X 光片中经常会被漏诊。本研究的目的是基于超声制定一种用于 SLIL 损伤的诊断分类，并评估其诊断准确性。
方法
本研究纳入了需要手术治疗桡骨远端骨折的患者。所有患者均接受超声和关节镜检查。最初基于超声的 SLIL 背侧分类如下：A 型，SLIL 表面清晰勾勒为连续的平线；B 型，SLIL 表面清晰勾勒为连续的凸起线；C 型，SLIL 表面不连续、不光滑或无法清晰勾勒。在骨合成时进行关节镜检查。我们根据 Geissler 等人的关节镜分类系统对其发现进行分类，并评估我们的超声分类的观察者间和观察者内可靠性。我们还研究了超声和关节镜分类之间的关系。
结果
本研究共纳入 40 例患者。我们的超声分类观察者间和观察者内可靠性的加权κ 值分别为 0.83（95%置信区间，0.70-0.96）和 0.88（95%置信区间，0.77-0.99）。超声检查结果为 A 型 17 例，B 型 14 例，C 型 9 例。超声检查对假设 C 型对应关节镜 Geissler 分级 3 和 4 的诊断具有 64%的敏感性和 93%的特异性。超声检查 A 型的患者无一例被归类为关节镜 Geissler 分级 3 和 4。
结论
我们得出结论，超声对 SLIL 损伤的诊断具有高特异性但低敏感性。
研究类型/证据水平：诊断性 2 级。
Zotero 插件