Wosar M A, Lewis D D, Neuwirth L, Parker R B, Spencer C P, Kubilis P S, Stubbs W P, Murphy S T, Shiroma J T, Stallings J T, Bertrand S G
Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville 32610-0126, USA.
J Am Vet Med Assoc. 1999 Jan 1;214(1):52-8.
To determine the usefulness of 5 radiographic projections of the elbow joint for identification of fragmented coronoid process (FCP) and associated secondary degenerative changes in dogs.
Longitudinal clinical study.
19 dogs suspected of having FCP (7 dogs, 1 elbow joint; 12 dogs, both elbow joints).
5 radiographic projections were obtained before and after surgery for all elbow joints on which exploratory arthrotomy was performed because of suspected FCP. Radiographs obtained before surgery were compared with radiographs obtained after surgery and radiographs taken of the excised fragments. Each projection was evalated for its utility in definitively identifying FCP and 7 specific degenerative changes. Interevaluator agreement, use of each radiographic projection for definitively identifying a feature, and ability of the 4 evaluators to definitively identify a feature were analyzed.
The craniolateral-caudomedial oblique (Cr15L-CdMO) projection had a significantly higher sensitivity for definitively identifying FCP, compared with the other 4 projections. Interevaluator and kappa agreement for the 5 projections did not differ significantly among the 7 degenerative changes evaluated. The radiographic projection with the highest sensitivity and specificity for detection of a particular degenerative change varied by feature.
Of the 5 radiographic projections evaluated, the Cr15L-CdMO projection provided the highest sensitivity and was the best projection to use for definitively identifying FCP. The craniocaudal, Cr15L-CdMO, and mediolateral projections most reliably allowed for identification of secondary degenerative changes.
确定肘关节的5种X线投照方式对识别犬类冠状突骨折碎片（FCP）及相关继发性退行性变的作用。
纵向临床研究。
19只疑似患有FCP的犬（7只犬，1个肘关节；12只犬，双侧肘关节）。
对因疑似FCP而进行探查性关节切开术的所有肘关节，在手术前后均获取5种X线投照影像。将术前获得的X线片与术后获得的X线片以及切除碎片的X线片进行比较。评估每种投照方式在明确识别FCP和7种特定退行性变方面的效用。分析评估者间的一致性、每种X线投照方式用于明确识别某一特征的情况以及4名评估者明确识别某一特征的能力。
与其他4种投照方式相比，颅外侧-尾内侧斜位（Cr15L-CdMO）投照在明确识别FCP方面具有显著更高的敏感性。在评估的7种退行性变中，5种投照方式的评估者间一致性和kappa一致性无显著差异。检测特定退行性变的敏感性和特异性最高的X线投照方式因特征而异。
在所评估的5种X线投照方式中，Cr15L-CdMO投照具有最高的敏感性，是明确识别FCP的最佳投照方式。颅尾位、Cr15L-CdMO位和内外侧位投照最可靠地有助于识别继发性退行性变。
