Center of Trauma and Orthopaedic Surgery Eisenach, Sophienstraße 16, D-99817, Eisenach, Germany.
Center of Radiology Eisenach and Eschwege, Mühlhäuser-Str. 94, D-99817, Eisenach, Germany.
Arch Orthop Trauma Surg. 2024 Aug;144(8):3313-3322. doi: 10.1007/s00402-024-05470-8. Epub 2024 Aug 6.
The aim of this study was to evaluate the interobserver reliability of measurements of the Acromiohumeral Distance (AHD) first described by Golding et al., the Critical Shoulder Angle (CSA), the Acromion Index with Glenoid Humeral (GH) and Glenoid Acromial (GA) distances, following the measuring method by Nyffeler et al., the Lateral Acromion Angle (LAA), as well as the morphology of the acromion according to Bigliani and the humeral head position according to Maloney in X-rays and MRI. Furthermore, the study assessed the correlation of measurement results in X-ray with those in MRI for AHD, CSA, GA, GH, AI, and LAA.
A total of 187 patients who underwent shoulder joint X-ray and MRI examinations from 09/2016 to 05/2023 were included in the study. Patients with poor imaging quality, arthrosis or radical prior surgeries, like shoulder prosthetic surgery, status post humerus fractures, that have undergone surgery and therefore changed the anatomical features were excluded, what lead to a total study population of 78. X-ray measurements were performed by two observers in the true anteroposterior view, so that the humeral head and the glenoid are shown without overlap, providing a clear view into the joint space. MRI measurements were performed in oblique coronal MRI slices, using the most accurately depicted glenoid surface as a landmark.
Interobserver measurement results showed a significance with p < 0.001 for the assessment of acromion type according to Bigliani, humeral head offset assessment according to Maloney, and AHD. No significance was found for interobserver reliability in measuring LAA. Additionally, there was a high correlation of measurement results in X-ray with measurements in MRI for, CSA, GH/GA, and consequently AI, a good correlation for AHD but no correlation could be shown for LAA.
These findings provide valuable insights into the robustness of radiological parameters for evaluating shoulder pathology, offering promising prospects for clinical applications and further research. Nevertheless, the specific methodological considerations and patient characteristics should be taken into account when interpreting the results to ensure their accurate application in clinical practice.
本研究旨在评估 Golding 等人首次描述的肩峰肱骨关节间隙（AHD）、临界肩角（CSA）、肩峰与肩胛盂（GH）和肩胛盂与肩峰（GA）距离的关节指数、Nyffeler 等人的测量方法、外侧肩峰角（LAA）以及 X 射线和 MRI 中肩峰形态的观察者间可靠性。此外，本研究还评估了 X 射线测量结果与 MRI 测量结果在 AHD、CSA、GA、GH、AI 和 LAA 之间的相关性。
本研究共纳入 2016 年 9 月至 2023 年 5 月期间接受肩关节 X 射线和 MRI 检查的 187 例患者。排除了成像质量差、关节炎或先前激进手术（如肩关节置换术）、肱骨骨折后状态、已接受手术且因此改变解剖特征的患者，最终研究人群为 78 例。X 射线测量由两名观察者在真正的前后位视图中进行，以便在不重叠的情况下显示肱骨头和肩胛盂，清晰显示关节间隙。MRI 测量在斜冠状 MRI 切片中进行，使用最准确描绘的肩胛盂表面作为标志。
根据 Bigliani 评估肩峰类型、根据 Maloney 评估肱骨头偏移以及 AHD 的观察者间测量结果具有统计学意义（p<0.001）。LAA 的观察者间可靠性测量结果无统计学意义。此外，X 射线测量结果与 MRI 测量结果在 CSA、GH/GA 以及相应的 AI 方面高度相关，AHD 具有良好的相关性，但 LAA 无相关性。
这些发现为评估肩部病变的放射学参数的稳健性提供了有价值的见解，为临床应用和进一步研究提供了有前景的方向。然而，在解释结果时应考虑特定的方法学考虑因素和患者特征，以确保其在临床实践中的准确应用。
