Shapiro Lauren M, Schultz Emily A, Welch Jessica, Zhuang Thompson, Kamal Robin N
Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA.
VOICES Health Policy Research Center, Stanford University, Redwood City, CA.
J Hand Surg Am. 2025 Feb;50(2):182-187. doi: 10.1016/j.jhsa.2024.10.008. Epub 2024 Nov 28.
The use of magnetic resonance imaging (MRI) for evaluation of scaphoid nonunion may be an example of low-value imaging for the treatment of scaphoid nonunion. The purpose of this study was to investigate variation in MRI use for scaphoid nonunion, the association of MRI with a vascularized bone graft (VBG) and to develop consensus on MRI use for scaphoid nonunion.
We identified patients >18 years of age who underwent scaphoid nonunion surgery between 2010 and 2019 using a claims database. Patients who had, and did not have, an MRI within 90 days prior to their diagnosis of scaphoid nonunion were included and a multivariable analysis was performed to evaluate variation in MRI and VBG use. Subsequently, a literature review was performed, and a preliminary consensus statement was developed pertaining to the routine use of MRI for scaphoid nonunion. A consortium of nine hand surgeons evaluated the importance, feasibility, usability, and scientific acceptability of the statement through a modified RAND Coroporation/University of California, Los Angeles Delphi. Panelists evaluated the statement in two voting rounds with an intervening face-to-face discussion.
We identified 1,324 eligible patients with surgical repair of a scaphoid nonunion. Two hundred and sixty-three (19.9%) underwent an MRI within 90 days prior to surgery. Differences in age, insurance type, and comorbidity burden existed between patients who received MRI and those who did not. The MRI cohort was more likely to receive VBG (10.6%) compared to those without an MRI (4.7%). Panelists agreed on the voting domains of the consensus statement and therefore the statement, "There is no benefit of routine MRI/MRA in the treatment of scaphoid nonunion with or without presumed avascular necrosis," was considered valid.
MRI use within 90 days of surgical repair of scaphoid nonunion varies, is associated with greater rates of VBG use, and may represent low-value imaging given the lack of sufficient evidence on this topic.
As MRI use for scaphoid nonunion varies and may represent low-value imaging, a validated consensus statement may help guide the evaluation of patients with scaphoid nonunion.
使用磁共振成像（MRI）评估舟骨不愈合可能是用于治疗舟骨不愈合的低价值成像的一个例子。本研究的目的是调查MRI在舟骨不愈合评估中的使用差异、MRI与带血管骨移植（VBG）的关联，并就MRI在舟骨不愈合评估中的使用达成共识。
我们使用索赔数据库确定了2010年至2019年间接受舟骨不愈合手术的18岁以上患者。纳入在诊断舟骨不愈合前90天内进行了MRI检查和未进行MRI检查的患者，并进行多变量分析以评估MRI和VBG使用的差异。随后，进行了文献综述，并制定了一份关于MRI在舟骨不愈合常规应用的初步共识声明。由九名手外科医生组成的联盟通过改进的兰德公司/加利福尼亚大学洛杉矶分校德尔菲法评估了该声明的重要性、可行性、实用性和科学可接受性。小组成员在两轮投票中对声明进行评估，并进行了一次面对面的讨论。
我们确定了1324例接受舟骨不愈合手术修复的合格患者。263例（19.9%）在手术前90天内进行了MRI检查。接受MRI检查的患者与未接受MRI检查的患者在年龄、保险类型和合并症负担方面存在差异。与未进行MRI检查的患者（4.7%）相比，进行MRI检查的队列更有可能接受VBG（10.6%）。小组成员在共识声明的投票领域达成一致，因此声明“对于伴有或不伴有假定无血管坏死的舟骨不愈合，常规MRI/MRA治疗无益处”被认为是有效的。
舟骨不愈合手术修复前90天内MRI的使用存在差异，与更高的VBG使用率相关，鉴于该主题缺乏充分证据，可能代表低价值成像。
由于MRI在舟骨不愈合评估中的使用存在差异且可能代表低价值成像，一份经过验证的共识声明可能有助于指导舟骨不愈合患者的评估。
