Kjær Morten, Radev Dimitar Ivanov, Gvozdenovic Robert
Department of Orthopedic Surgery, Hand Surgery Unit, Herlev-Gentofte University Hospital of Copenhagen, Copenhagen, Denmark.
Department of Radiology, Bispebjerg and Frederiksberg University Hospital of Copenhagen, Copenhagen, Denmark.
J Hand Surg Glob Online. 2024 Sep 14;6(6):865-869. doi: 10.1016/j.jhsg.2024.08.005. eCollection 2024 Nov.
Assessment of scaphoid union after operative treatment might be associated with uncertainty, disagreement, and misinterpretation. Union is defined as consolidation on three of four X-ray views. Computed tomography (CT) scans are increasingly used to evaluate union of scaphoid fractures and nonunion. It allows multiplanar assessment of the scaphoid. Reliability in CT scan assessment of union after operative intervention is limited. We hypothesized that inter- and intraobserver reliability of the CT scan assessment of union after operative treatment for scaphoid fracture and nonunion are substantial and better in fracture cases.
An institutional search identified 230 patients with operative intervention. According to the sample size, we randomly selected 60 patients (30 fractures and 30 nonunion), with age above 18 years and CT scans 6-26 weeks after surgery, when uncertainty about healing status is most pronounced. Three observers evaluated the CT scans on two occasions 6 weeks apart. Observers classified the scaphoid into two categories: No/partial/full union and >/<50% union.
Interrater agreement in no/partial/full union was overall substantial, substantial in fractures, and moderate for nonunion cases. Interobserver agreement for >/<50% union was overall moderate and moderate for both fractures and nonunion groups. The interrater agreement of no/partial/full union with CT scans ≥12 weeks after surgery was substantial versus fair for the cases below. Intrarater agreement was overall better in cases with CT scans ≥12 weeks postoperative versus earlier.
CT scans show substantial agreement in the assessment of no/partial/full union after operative intervention, although the presence of metal artifacts and bone grafts potentially impair visibility among observers. The agreement was better in scaphoid fractures. CT scan assessment of >/<50% union is with overall moderate agreement. Inter- and intrarater agreement is improved when CT scans are taken 12 weeks or later after operative treatment, blinded to the clinical information.
Diagnostic, III.
手术治疗后舟骨愈合情况的评估可能存在不确定性、分歧和误解。愈合定义为在四张X线片中有三张显示骨痂形成。计算机断层扫描（CT）越来越多地用于评估舟骨骨折的愈合及骨不连情况。它能够对舟骨进行多平面评估。手术干预后CT扫描评估愈合情况的可靠性有限。我们推测，手术治疗舟骨骨折和骨不连后，CT扫描评估愈合情况的观察者间及观察者内信度较高，且在骨折病例中表现更佳。
通过机构检索确定了230例接受手术干预的患者。根据样本量，我们随机选择了60例患者（30例骨折和30例骨不连），年龄在18岁以上，术后6 - 26周进行了CT扫描，此时愈合状态的不确定性最为明显。三名观察者在相隔6周的两个时间点对CT扫描进行评估。观察者将舟骨分为两类：无/部分/完全愈合和> / <50%愈合。
在无/部分/完全愈合方面，观察者间一致性总体较高，骨折病例中较高，骨不连病例中为中等。对于> / <50%愈合，观察者间一致性总体为中等，骨折组和骨不连组均为中等。术后≥12周CT扫描显示无/部分/完全愈合的观察者间一致性较高，而术后<12周的病例一致性为一般。观察者内一致性在术后≥12周的病例中总体优于早期病例。
尽管存在金属伪影和骨移植可能会影响观察者的视野，但CT扫描在手术干预后评估无/部分/完全愈合方面显示出较高的一致性。在舟骨骨折中一致性更好。对于> / <50%愈合的CT扫描评估总体一致性为中等。当手术治疗12周或更晚后进行CT扫描且不了解临床信息时，观察者间及观察者内一致性会得到改善。
诊断性研究，III级
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