Hoogervorst Paul, van Geene Arnoud, Gundlach Udo, Wei Abel, Verdonschot Nico, Hannink Gerjon
Department of Orthopaedic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
JSES Int. 2020 May 18;4(3):503-507. doi: 10.1016/j.jseint.2020.03.005. eCollection 2020 Sep.
Radiographic measurements of shortening and vertical displacement in the fractured clavicle are subject to a variety of factors such as patient positioning and projection. The aims of this study were (1) to quantify differences in shortening and vertical displacement in varying patient positions and X-ray projections, (2) to identify the view and patient positioning indicating the largest amount of shortening and vertical displacement, and (3) to identify and quantify the inter- and intraobserver agreement.
A prospective clinical measurement study of 22 acute Robinson type 2B1 clavicle fractures was performed. Each patient underwent 8 consecutive standardized and calibrated X-rays in 1 setting.
In the upright patient position, the difference of absolute shortening was 4.5 mm (95% confidence interval [CI]: 3.0-5.9, < .0001) larger than in the supine patient position. For vertical displacement, the odds of being scored a category higher in the upright patient position were 4.7 (95% CI: 2.2-9.8) times as large as the odds of being scored a category higher in supine position. The odds of being scored a category higher on the caudocranial projection were 5.9 (95% CI: 2.8-12.6) times as large as the odds of being scored a category higher on the craniocaudal projection.
Absolute shortening, relative shortening, and vertical displacement were found to be the greatest in the upright patient positioning with the arm protracted orientation on a 15° caudocranial projection. No statistically significant differences were found for a change in position of the arm between neutral and protracted.
锁骨骨折缩短和垂直移位的影像学测量受多种因素影响，如患者体位和投照方式。本研究的目的是：（1）量化不同患者体位和X线投照方式下缩短和垂直移位的差异；（2）确定显示最大缩短和垂直移位量的视图和患者体位；（3）确定并量化观察者间和观察者内的一致性。
对22例急性罗宾逊2B1型锁骨骨折患者进行前瞻性临床测量研究。每位患者在同一环境下连续接受8次标准化和校准的X线检查。
在直立位患者中，绝对缩短差异比仰卧位患者大4.5 mm（95%置信区间[CI]：3.0 - 5.9，P <.0001）。对于垂直移位，直立位患者被评为更高等级的几率是仰卧位患者的4.7倍（95% CI：2.2 - 9.8）。在尾头位投照中被评为更高等级的几率是颅尾位投照的5.9倍（95% CI：2.8 - 1,2.6）。
发现在直立位患者体位下，手臂伸展并采用15°尾头位投照时，绝对缩短、相对缩短和垂直移位最大。手臂从中立位到伸展位的位置变化未发现统计学上的显著差异。
