Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain; Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.
Department of Rheumatology, Hospital Universitario de Móstoles, Madrid, Spain; Faculty of Medicine, Rey Juan Carlos University of Madrid, Madrid, Spain.
Ultrasound Med Biol. 2024 Dec;50(12):1903-1910. doi: 10.1016/j.ultrasmedbio.2024.08.018. Epub 2024 Sep 16.
The objectives of this ultrasound and anatomical study were: (1) To evaluate the reliability of ultrasound identification of the enthesis of the central slip of the extensor digitorum tendon (CSET) using cadaver specimens; (2) To assess the concordance of the measurement of the CSET thickness by ultrasound and gross anatomy; (3) To evaluate the variation in ultrasound identification of the CSET enthesis in a cadaveric experimental model of PIP synovitis.
Four rheumatologist ultrasonographers blindly and independently measured by ultrasound the CSET enthesis thickness in the second to fifth fingers of 8 hands from fresh-frozen human cadavers in two rounds. These fingers were dissected and the thickness of the CSET measured by the anatomist. In addition, an artificial synovitis was created in the proximal interphalangeal (PIP) joints of a different cadaveric hand. The ultrasonographic CSET enthesis thickness was measured by the four investigators before and after intra-articular ultrasound guided injection of material.
Intra- and inter-observer reliability of CSET enthesis thickness measurement were good to excellent (ICC 0.93 for intra-observer agreement and 0.89-0.92 for inter-observer agreement). Ultrasound measurements were consistent and only slightly smaller than the anatomical ones (µ = -0.039 mm). The differences between the measurements of CSET enthesis thickness before and after the synovitis model were not statistically significant.
Ultrasound demonstrated high multiobserver reliability and agreement with gross anatomy in identifying the CSET enthesis and discriminated it from the capsular tissue of the PIP. Furthermore, an experimental model of PIP synovitis did not interfere with its identification.
本超声和解剖研究的目的是：（1）评估使用尸体标本超声识别伸肌腱中央束（CSET）附着点的可靠性；（2）评估超声和大体解剖测量 CSET 厚度的一致性；（3）评估 PIP 关节炎尸体实验模型中 CSET 附着点超声识别的变异性。
4 名风湿病超声医师在两轮中分别独立地对 8 只手的第二至第五指的 CSET 附着点厚度进行超声测量。这些手指被解剖，由解剖学家测量 CSET 的厚度。此外，在另一只尸体手的近侧指间关节（PIP）关节中创建了人工滑膜炎。四名研究人员在关节内超声引导注射材料前后分别通过超声测量 CSET 附着点的厚度。
CSET 附着点厚度的观察者内和观察者间的可靠性均良好至极好（观察者内一致性的 ICC 为 0.93，观察者间一致性的 ICC 为 0.89-0.92）。超声测量值与解剖值一致，仅略小（µ = -0.039 毫米）。滑膜炎模型前后 CSET 附着点厚度的测量值之间无统计学差异。
超声在识别 CSET 附着点方面具有很高的多观察者可靠性和与大体解剖学的一致性，并将其与 PIP 的囊组织区分开来。此外，PIP 滑膜炎的实验模型并不干扰其识别。
