Jong Benjamin Y, MacDonald Peter B, Regan William D, Leiter Jeff R, Sayre Eric C, Sasyniuk Treny M, Goel Danny P
Pan Am Clinic and University of Manitoba, Winnipeg, Canada.
University of British Columbia and Department of Orthopaedics, Vancouver BC, Canada.
JSES Int. 2020 Nov 24;5(1):66-71. doi: 10.1016/j.jseint.2020.09.012. eCollection 2021 Jan.
To explore whether patient position influences a surgeon's ability to accurately judge anchor position on the glenoid.
Two anchors were inserted into the glenoid of 8 shoulders. Arthroscopic videos were taken from 3 views (posterior beach chair [pBC], posterior lateral decubitus [pLD], and anterosuperolateral decubitus [asLD]). The shoulders were disarticulated to identify "true" anchor position. Seventeen shoulder surgeons reviewed the videos and indicated anchor positions using the "clock face" method. Accuracy was measured within tolerances, ranging from zero (exact), 0.5 (half-hour), 1.0, and 1.5 hours of "true" position. Intra- and inter-rater agreement was calculated. Post hoc analyses explored for bias dependent on surgical side.
The overall accuracy was 34.0%. At tolerances of 0.5, 1.0, and 1.5 hours, accuracy increased to 82.4%, 95.4%, and 98.0%. With a 30° scope, identification of exact position was more accurate in pBC than pLD (odds ratio [OR] = 1.397; = .029) but not asLD (OR =1.341; = .197). At a tolerance of 0.5 hour, the 30° scope was more accurate in pBC than both pLD (OR = 1.444; = .011) and asLD (OR = 1.728; = .009). In left shoulders, anchors were perceived as more inferior than true position in asLD and pLD. In right shoulders, anchors were perceived as more superior than true position from pBC and pLD. Inter- and intrarater agreement were highest in pBC with a 30° scope (30° scope weighted kappa = 0.783 and 70° scope weighted kappa = 0.853, respectively).
Judgment of anchor position on video is most accurate in a pBC view. Inter- and intrarater reliability were also highest from a pBC view.
探讨患者体位是否会影响外科医生准确判断肩胛盂上锚钉位置的能力。
在8个肩部的肩胛盂中插入两枚锚钉。从三个视角（后倾位[PBC]、后外侧卧位[PLD]和前上外侧卧位[ASLD]）拍摄关节镜视频。将肩部进行关节离断以确定“真实”的锚钉位置。17位肩部外科医生观看视频，并使用“钟面”法指出锚钉位置。在从零（精确）、0.5（半小时）、1.0和1.5小时的“真实”位置的容差范围内测量准确性。计算评分者内和评分者间的一致性。事后分析探讨了取决于手术侧别的偏差。
总体准确率为34.0%。在0.5、1.0和1.5小时的容差下，准确率分别提高到82.4%、95.4%和98.0%。使用30°关节镜时，在PBC位比在PLD位更能准确识别精确位置（优势比[OR]=1.397；P=.029），但与ASLD位相比无差异（OR=1.341；P=.197）。在0.5小时的容差下，30°关节镜在PBC位比在PLD位（OR=1.444；P=.011）和ASLD位（OR=1.728；P=.009）更准确。在左肩，在ASLD位和PLD位时，锚钉被感知的位置比真实位置更低。在右肩，从PBC位和PLD位看，锚钉被感知的位置比真实位置更高。评分者间和评分者内一致性在使用30°关节镜的PBC位时最高（30°关节镜加权kappa分别为0.783和70°关节镜加权kappa为0.853）。
在视频上判断锚钉位置在PBC视角下最准确。评分者间和评分者内可靠性从PBC视角看也最高。
