Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
J Shoulder Elbow Surg. 2024 Jul;33(7):1615-1623. doi: 10.1016/j.jse.2024.01.050. Epub 2024 Mar 20.
Ultrasonography (US) has been suggested as a valuable complement to clinical and radiologic examinations in elbow trauma. Magnetic resonance imaging (MRI) has been the method of choice, despite fair to moderate inter-rater reliability (IRR). US has potential advantages but is assessor dependent and the IRR scarcely examined. The primary aim of the present study was to investigate IRR for US and secondarily interobserver agreement (IOA) between US and MRI in the acute phase after elbow trauma. Acute phase was defined as 2 weeks and, if applicable, the following weekend. The hypothesis was that US reliability would be at least substantial for complete muscle or ligament lesions.
A total of 116 patients (50 men, median age 47 [range 19-87] years) who had an elbow trauma with dislocation and/or fracture were included. Exclusion criteria were prior injury to the same elbow, and US and/or MRI not possible within 16 days. During US, the condition of muscle origins at the epicondyles and collateral and annular ligament complexes was recorded in a predesigned protocol, with the alternatives intact, partially or completely torn. Seventy-two patients had a second US examination the same day by an independent upper extremity surgeon, and 58 of the 116 patients underwent an MRI before or after the US, evaluated by 2 radiologists using the same protocol. IOA and IRR between assessors and modalities were analyzed with kappa statistics and interpreted according to Landis and Koch. Perfect agreement (PA) was reported in percentages.
US examination within 2 weeks was feasible with tolerable discomfort. Defining muscle origins and ligaments as intact or completely torn, the US IRR ranged from substantial to near perfect (kappa 0.63-1, PA 93%-100%). Intact tissues vs. tear (partial and complete tear combined) or intact vs. partial vs. complete tear resulted in kappa values from moderate to substantial and PA 74%-96% with lowest reliability for the muscle origins. The IOA between MRI and US ranged from fair to near perfect for no tear vs. complete tear (kappa 0.25-1, PA 65%-100%). Agreement between no tear and tear (partial and complete together) ranged from fair to substantial (0.25-0.66, PA 63%-89%) and no tear vs. partial or complete tear ranged from fair to moderate (0.25-0.53, PA 50%-79%).
US in the acute setting is suitable and reliable for diagnosis of ligament injuries in the elbow and is in addition fast, cheap, and easily accessible. The agreement with MRI seems to vary with the structure assessed and severity of the lesions, ranging from fair to near perfect.
超声检查（US）已被建议作为肘部创伤临床和放射学检查的有价值的补充。尽管磁共振成像（MRI）具有相当或中等的观察者间可靠性（IRR），但它仍是首选方法。US 具有潜在的优势，但它依赖于评估者，并且很少评估其 IRR。本研究的主要目的是研究 US 的 IRR，其次是肘部创伤后急性阶段 US 和 MRI 之间的观察者间一致性（IOA）。急性阶段定义为 2 周，如果适用，则为随后的周末。假设 US 的可靠性对于完全的肌肉或韧带损伤至少是实质性的。
共纳入 116 例（50 例男性，中位年龄 47 岁[范围 19-87 岁]），这些患者肘部有脱位和/或骨折。排除标准为同一肘部既往损伤，以及 16 天内无法进行 US 和/或 MRI。在 US 检查期间，使用预定的方案记录肘突上的肌肉起点和侧副及环状韧带复合体的情况，替代物为完整、部分或完全撕裂。72 例患者在同一天由一位独立的上肢外科医生进行了第二次 US 检查，58 例 116 例患者在 US 前或后进行了 MRI，由 2 位放射科医生使用相同的方案进行评估。使用 Kappa 统计分析评估评估者和模态之间的 IOA 和 IRR，并根据 Landis 和 Koch 进行解释。报告了完美一致性（PA）的百分比。
在 2 周内进行 US 检查是可行的，且患者可以忍受不适。将肌肉起点和韧带定义为完整或完全撕裂，US 的 IRR 范围从实质性到近乎完美（kappa 0.63-1，PA 93%-100%）。完整组织与撕裂（部分和完全撕裂的组合）或完整组织与部分撕裂与完全撕裂相比，kappa 值从中度到实质性，PA 74%-96%，肌肉起点的可靠性最低。MRI 和 US 之间的 IOA 对于无撕裂与完全撕裂（kappa 0.25-1，PA 65%-100%）从良好到近乎完美。无撕裂与撕裂（部分和完全一起）之间的一致性从良好到实质性（0.25-0.66，PA 63%-89%），无撕裂与部分或完全撕裂之间的一致性从良好到中度（0.25-0.53，PA 50%-79%）。
在肘部急性情况下，US 适用于诊断韧带损伤，并且快速、廉价且易于获得。与 MRI 的一致性似乎因评估的结构和损伤的严重程度而异，范围从良好到近乎完美。
