Willems Annika, Houkes Christa M, Bierma-Zeinstra Sita M A, Meuffels Duncan E
Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
Eur J Radiol. 2022 Nov;156:110511. doi: 10.1016/j.ejrad.2022.110511. Epub 2022 Sep 5.
Many studies have been performed that investigate consolidation after arthrodesis of foot and ankle joints. Consolidation in foot and ankle joints is best assessed by computed tomography (CT). However, no golden-standard methodology exists for radiological consolidation assessment from CT after ankle and foot arthrodesis. The aim of this review is to present an overview of the radiological methodologies for consolidation assessment, outcomes on reliability and validity and to advise which methodology should be used.
Scientific databases were systematically searched. Eligible studies were studies that 1) performed foot or ankle arthrodesis, 2) mentioned radiological or CT follow-up in abstract, 3) performed postoperative CT in > 50% of patients. Two authors selected eligible studies and performed a risk of bias assessment with the COSMIN tool.
Risk of bias assessment showed that most studies (80%) were at high risk of bias due to poor methodology. The most popular method for consolidation assessment is by subjectively categorizing consolidation into consolidation groups, with a substantial reliability score. Another popular method is to calculate the fusion ratio and then apply a fusion threshold, to distinguish between fused and non-fused joints. This method had an excellent reliability score. In most studies a fusion threshold of 50% is used. However, four studies in this review showed that a 30% fusion threshold may by more valid.
Based on the results of this review we would advise to calculate fusion threshold and apply a 30% fusion threshold to distinguish fused from non-fused foot and ankle joints.
已经开展了许多研究来调查足踝关节融合后的骨愈合情况。足踝关节的骨愈合情况最好通过计算机断层扫描（CT）进行评估。然而，对于足踝关节融合术后通过CT进行放射学骨愈合评估，不存在金标准方法。本综述的目的是概述用于骨愈合评估的放射学方法、可靠性和有效性结果，并就应使用哪种方法提供建议。
系统检索科学数据库。符合条件的研究是指：1）进行了足或踝关节融合术；2）在摘要中提及了放射学或CT随访；3）对超过50%的患者进行了术后CT检查。两位作者选择符合条件的研究，并使用COSMIN工具进行偏倚风险评估。
偏倚风险评估表明，由于方法不佳，大多数研究（80%）存在高偏倚风险。最常用的骨愈合评估方法是主观地将骨愈合情况分类为不同的愈合组，可靠性得分较高。另一种常用方法是计算融合率，然后应用融合阈值来区分融合和未融合的关节。该方法的可靠性得分很高。在大多数研究中，使用的融合阈值为50%。然而，本综述中的四项研究表明，30%的融合阈值可能更有效。
基于本综述的结果，我们建议计算融合阈值，并应用30%的融合阈值来区分足踝关节的融合与未融合情况。
