Wilson Jacob M, Pflederer Jeremiah A, Schwartz Andrew M, Farley Kevin X, Reimer Nickolas B
Department of Orthopaedic Surgery, Atlanta, GA.
Arthroplast Today. 2021 Apr 15;8:226-230. doi: 10.1016/j.artd.2021.02.011. eCollection 2021 Apr.
Intraoperative vascular injury during total hip arthroplasty represents a catastrophic complication. Acetabular screw placement represents one possible mode of injury. The purpose of this study was to evaluate the utility of various fluoroscopic views in the detection of intrapelvic screw penetration.
A radiopaque pelvis Sawbones model was instrumented with a hemispherical acetabular component. Four intrapelvic quadrants were defined. Screws were placed, 3 in each quadrant, and imaged sequentially at 3 depths: 0 mm, 5 mm, and 10 mm penetrated. Eight fluoroscopic images were used: anteroposterior, inlet, outlet, iliac oblique, obturator oblique, "down the wing," obturator outlet, and a "quad" view. Three blinded, independent surgeons evaluated the images for intrapelvic screw penetration. Images were analyzed in isolation and as a "triple-shot series" consisting of the "quad," obturator outlet, and iliac oblique views. Sensitivity and specificity values were then calculated.
In isolation, the "quad" view had the highest sensitivity for screw penetration (62%). The triple-shot series was found to be 100% sensitive in all 4 quadrants for detecting 10 mm of screw penetration. The specificity of the series was found to be 100% in all quadrants except for the posterior superior quadrant where it was 67%. Interobserver agreement approached perfection (Kappa ≥0.947) between all surgeons ( < .001) when using the 3-view series.
This study is the first to assess the use of fluoroscopy in the detection of intrapelvic penetration of transacetabular screws. We found that a 3-radiograph series provided a sensitive and specific metric for the detection of intrapelvic screw penetration.
全髋关节置换术中的术中血管损伤是一种灾难性并发症。髋臼螺钉置入是一种可能的损伤方式。本研究的目的是评估各种透视视图在检测盆腔内螺钉穿透方面的效用。
用一个不透射线的骨盆Sawbones模型安装一个半球形髋臼组件。定义了四个盆腔内象限。在每个象限放置3枚螺钉，并在3个深度依次成像：穿透0毫米、5毫米和10毫米。使用了8张透视图像：前后位、入口位、出口位、髂骨斜位、闭孔斜位、“沿髂骨翼向下”、闭孔出口位和“四边形”视图。三名不知情的独立外科医生评估图像中是否存在盆腔内螺钉穿透。图像单独分析，并作为由“四边形”、闭孔出口位和髂骨斜位视图组成的“三联影像系列”进行分析。然后计算敏感性和特异性值。
单独来看，“四边形”视图对螺钉穿透的敏感性最高（62%）。发现三联影像系列在所有4个象限中对检测10毫米的螺钉穿透均为100%敏感。该系列在除后上象限（特异性为67%）外的所有象限中的特异性均为100%。当使用三联视图系列时，所有外科医生之间的观察者间一致性接近完美（Kappa≥0.947，P<0.001）。
本研究首次评估了透视在检测经髋臼螺钉盆腔内穿透方面的应用。我们发现，三张X线片系列为检测盆腔内螺钉穿透提供了一种敏感且特异的指标。
