Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France.
Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Nice, France.
J Bone Joint Surg Am. 2024 Feb 21;106(4):315-322. doi: 10.2106/JBJS.23.00173. Epub 2023 Nov 23.
Three-dimensional (3D) preoperative planning is increasingly used in orthopaedic surgery. Two-dimensional (2D) characterization of distal radial deformities remains inaccurate, and 3D planning requires a reliable reference frame at the wrist. We aim to evaluate the reliability of the determination of anatomical points placed manually on 3D models of the radius to determine which of those points allow reliable morphometric measurements.
Twenty-three radial scans were reconstructed in 3D. Five operators specialized in the upper limb manually positioned 8 anatomical points on each model. One of the operators repeated the operation 6 times. The anatomical points were based on previously published 3D models used for radial inclination and dorsopalmar tilt measurements. The repeatability and reproducibility of the measurements derived using this manual landmarking were calculated using different measurement methods based on the identified points. An error of ≤2° was considered clinically acceptable.
This study of intraobserver and interobserver variability of the anatomic points allowed us to determine the least variable and most accurately defined points. The middle of the ulnar border of the radius, the radial styloid, and the midpoint of the ulnar incisura of the radius were the least variable. The palmar and dorsal ends of the ridge delineating the scaphoid and lunate facets were the most variable. Only 1 of the radial inclination measurement methods was clinically acceptable; the others had a repeatability and reproducibility limit of >2°, making those measurements clinically unacceptable.
The use of isolated points seems insufficient for the development of a wrist reference frame, especially for the purpose of measuring dorsopalmar tilt. If one concurs that an error of 2° is unacceptable for all distal radial measurements, then clinicians should avoid using 3D landmarked points, due to their unreliability, except for radial inclination measured using the radial styloid and the midpoint of the ulnar edge of the radius. A characterization of the wrist using 3D shapes that fit the articular surface of the radius should be considered.
Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
三维（3D）术前规划在矫形外科中越来越多地被使用。二维（2D）描述桡骨远端畸形仍然不准确，而 3D 规划需要在腕部有一个可靠的参考框架。我们旨在评估手动放置在桡骨 3D 模型上的解剖点的确定的可靠性，以确定哪些点允许进行可靠的形态测量。
对 23 个桡骨扫描进行 3D 重建。5 名专门从事上肢的操作员在每个模型上手动定位 8 个解剖点。其中一名操作员重复操作 6 次。这些解剖点基于先前发表的用于桡骨倾斜度和背掌倾斜度测量的 3D 模型。使用这种手动地标测量得到的测量的重复性和再现性使用不同的测量方法基于确定的点进行计算。≤2°的误差被认为是临床可接受的。
这项关于解剖点的观察者内和观察者间变异性的研究使我们能够确定最可变和最准确定义的点。桡骨尺侧缘的中点、桡骨茎突和桡骨切迹的尺侧中点是最可变的。界定舟状骨和月状骨关节面的脊的掌侧和背侧末端是最可变的。只有一种桡骨倾斜测量方法是临床可接受的；其他方法的重复性和再现性限值>2°，使得这些测量在临床上不可接受。
使用孤立的点似乎不足以开发腕关节参考框架，特别是对于测量背掌倾斜度的目的。如果有人认为所有桡骨远端测量的 2°误差是不可接受的，那么由于其不可靠性，临床医生应该避免使用 3D 标记点，除了使用桡骨茎突和桡骨尺侧缘中点测量的桡骨倾斜度。应该考虑使用与桡骨关节面拟合的 3D 形状对腕关节进行特征描述。
诊断级别 III。有关证据水平的完整描述，请参见作者说明。
