Leal R A, Lambrechts N E, Crowley J D, Griffin J F, Karnia J J, Torres B T, Maritato K C, Kieves N R, Duerr F M
College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States.
Small Animal Specialist Hospital, North Ryde, NSW, Australia.
Front Vet Sci. 2023 Apr 6;10:1147386. doi: 10.3389/fvets.2023.1147386. eCollection 2023.
Accurate radiographic assessment of bone healing is vital in determining both clinical treatment and for assessing interventions aimed at the promotion of bone healing. Several scoring systems have been used to evaluate osteotomy changes following tibial plateau leveling osteotomy (TPLO). The goal of this study was to compare the ability of five radiographic scoring systems to identify changes in bone healing following TPLO over time (Aim I), and to evaluate the influence of limb positioning on TPLO osteotomy scoring (Aim II).
Phase I-A randomized, blinded, prospective study was conducted using similarly positioned postoperative TPLO radiographs from seven dogs taken immediately postoperatively, 6-weeks, and 8-weeks postoperatively. Ten reviewers assessed the radiographs, and five different scoring systems were tested for each set including three previously published ones, a Visual Analog Score (VAS), and a subjective 11-point scale. For each system, responses for 6-week postoperative were compared to 8-week postoperative. Scores were judged as correct (=showing an increase in score), incorrect (=decrease in score), or unchanged (=same score). Phase II-An international group of 39 reviewers was asked to score radiographs from three dogs, taken in different positions, using the VAS grading system. Scores were averaged and comparisons were made for each set.
Phase I-The VAS system identified the greatest number of sets correctly (76%), with the least unchanged scores (15%), and 9% incorrect scores. Phase II-All three patients had an increase in the average difference between VAS-scores for differently positioned radiographs compared to similarly positioned radiographs. The magnitude of change between different positions far exceeded the magnitude of comparison of the similarly positioned radiographs from the 6- and 8-week time point.
DISCUSSION/CONCLUSION: The VAS system appears to be the most appropriate of the tested systems to identify small changes in bone healing. In addition, the positioning of postoperative TPLO radiographs makes a substantial difference in the healing score that is assigned. Care must be undertaken when performing postoperative radiographs in both the clinical and research setting to ensure accurate assessment of bone healing.
准确的影像学评估骨愈合对于确定临床治疗以及评估旨在促进骨愈合的干预措施至关重要。已有多种评分系统用于评估胫骨平台水平截骨术（TPLO）后的截骨变化。本研究的目的是比较五种影像学评分系统随时间识别TPLO术后骨愈合变化的能力（目标I），并评估肢体位置对TPLO截骨评分的影响（目标II）。
第一阶段——采用七只犬术后即刻、术后6周和8周时位置相似的TPLO术后X线片进行一项随机、双盲、前瞻性研究。十名评估者对X线片进行评估，对每组X线片测试五种不同的评分系统，包括三种先前发表的系统、视觉模拟评分（VAS）和主观11分制。对于每个系统，将术后6周的反应与术后8周的反应进行比较。评分被判定为正确（=评分增加）、错误（=评分降低）或不变（=评分相同）。第二阶段——邀请一个由39名评估者组成的国际小组使用VAS分级系统对三只处于不同位置的犬的X线片进行评分。对评分进行平均，并对每组进行比较。
第一阶段——VAS系统正确识别的组数最多（76%），评分不变的最少（15%），错误评分占9%。第二阶段——与位置相似的X线片相比，所有三名患者不同位置的X线片的VAS评分平均差异均有所增加。不同位置之间的变化幅度远远超过6周和8周时间点位置相似的X线片的比较幅度。
讨论/结论：VAS系统似乎是所测试系统中识别骨愈合微小变化最合适的系统。此外，TPLO术后X线片的位置对所分配的愈合评分有很大影响。在临床和研究环境中进行术后X线检查时必须谨慎，以确保对骨愈合进行准确评估。
