Taillac Heather, Holzgrefe Russell, Hao Kevin A, Hones Keegan M, Wright Thomas W, King Joseph J, Satteson Ellen, Matthias Robert C
Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL.
College of Medicine, University of Florida, Gainesville, FL.
J Hand Surg Am. 2024 Dec;49(12):1273.e1-1273.e6. doi: 10.1016/j.jhsa.2023.04.012. Epub 2023 May 27.
Carpal angles traditionally are measured on the lateral projection of a standard wrist series; however, this often necessitates obtaining additional radiographic views resulting in additional radiation exposure and increased cost. We aimed to determine whether carpal angles could be measured accurately on a standard series of hand radiographs when compared to wrist radiographs.
Carpal indices were measured on lateral wrist and hand radiographs of 40 patients by three orthopedic upper extremity surgeons. Inclusion criteria were no metabolic disease, no hardware, no fractures, radiographic positioning of the wrist in flexion/extension <20°, minimum 3 cm of distal radius visible, and acceptable scaphopisocapitate relationship (defined as the volar cortex of the pisiform lying between the volar cortices of the distal pole of the scaphoid and capitate). Angles measured included radioscaphoid (RSA), radiolunate (RLA), scapholunate (SLA), capitolunate (CLA), and radiocapitate (RCA). Measurements on wrist versus hand radiographs were compared for each patient. Interclass correlation coefficients (ICCs) were computed to assess interrater and intrarater agreement.
Interrater agreement for hand and wrist radiographs were (respectively): SLA 0.746 and 0.763, RLA 0.918 and 0.933, RCA 0.738 and 0.538, CLA 0.825 and 0.650, RSA 0.778 and 0.829. Interrater agreement was superior in favor of hand radiographs for the RCA (0.738 [0.605-0.840] vs 0.538 [0.358-0.700]) and CLA (0.825 [0.728-0.896] vs 0.650 [0.492-0.781]), but not the SLA, RLA, or RSA. Two of the three raters had excellent intrarater agreement for all hand radiograph measures (ICC range, 0.907-0.995). The mean difference in measured angles on hand versus wrist radiographs was <5° for all angles.
Carpal angles may be measured reliably on hand radiographs with an acceptable scaphopisocapitate relationship and wrist flexion/extension of <20°.
By mitigating the need to obtain additional radiographic views, surgeons may be able to reduce the cost and radiation exposure to their patients.
腕骨角传统上是在标准腕部系列的侧位片上测量；然而，这通常需要获取额外的X线片，从而导致额外的辐射暴露和成本增加。我们旨在确定与腕部X线片相比，在标准手部X线片系列上是否能准确测量腕骨角。
由三位骨科上肢外科医生对40例患者的腕部和手部侧位X线片测量腕骨指数。纳入标准为无代谢疾病、无植入物、无骨折、腕部在屈伸位的X线片定位<20°、桡骨远端可见至少3 cm，以及舟月头关系可接受（定义为豌豆骨的掌侧皮质位于舟骨远端极和头状骨的掌侧皮质之间）。测量的角度包括桡舟角（RSA）、桡月角（RLA）、舟月角（SLA）、头月角（CLA）和桡头角（RCA）。对每位患者的腕部和手部X线片测量结果进行比较。计算组内相关系数（ICC）以评估评分者间和评分者内的一致性。
手部和腕部X线片的评分者间一致性分别为：SLA为0.746和0.763，RLA为0.918和0.933，RCA为0.738和0.538，CLA为0.825和0.650，RSA为0.778和0.829。对于RCA（0.738 [0.605 - 0.840] 对 0.538 [0.358 - 0.700]）和CLA（0.825 [0.728 - 0.896] 对 0.650 [0.492 - 0.781]），评分者间一致性在手部X线片方面更优，但SLA、RLA或RSA并非如此。三位评分者中有两位对所有手部X线片测量的评分者内一致性极佳（ICC范围为0.907 - 0.995）。手部和腕部X线片测量角度的平均差异对于所有角度均<5°。
在舟月头关系可接受且腕部屈伸<20°的情况下，可在手部X线片上可靠地测量腕骨角。
通过减少获取额外X线片的需求，外科医生或许能够降低患者的成本和辐射暴露。
