肩胛骨骨折和未愈合手术后计算机断层扫描评估愈合的观察者间和观察者内可靠性

Q3 Medicine Journal of Hand Surgery Global Online Pub Date : 2024-11-01 DOI:10.1016/j.jhsg.2024.08.005

Morten Kjær MD , Dimitar Ivanov Radev MD , Robert Gvozdenovic MD, PhD

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引用次数: 0

摘要

目的手术治疗后对肩胛骨结合的评估可能存在不确定性、分歧和误读。在四个 X 光切面中，有三个切面出现骨结合即为骨结合。计算机断层扫描（CT）越来越多地用于评估肩胛骨骨折的愈合和未愈合情况。它可以对肩胛骨进行多平面评估。CT 扫描评估手术干预后骨结合的可靠性有限。我们假设，肩胛骨骨折和不愈合手术治疗后，CT 扫描评估结合的观察者间和观察者内可靠性都很高，而且骨折病例的可靠性更高。根据样本量，我们随机选取了 60 例患者（30 例骨折和 30 例不愈合），年龄均在 18 岁以上，CT 扫描时间为术后 6-26 周，此时愈合状况的不确定性最为明显。三名观察者两次评估 CT 扫描结果，每次间隔 6 周。观察者将肩胛骨分为两类：结果无/部分/完全愈合的观察者之间的一致性总体上很高，骨折的观察者之间的一致性很高，非愈合病例的观察者之间的一致性一般。50%结合的观察者之间的一致性总体为中等，骨折和未愈合组的观察者之间的一致性为中等。术后≥12周的CT扫描结果显示，无/部分/完全愈合的观察者之间的一致性很高，而以下病例的一致性尚可。结论 CT 扫描显示，尽管金属伪影和植骨的存在可能会影响观察者之间的可视性，但在评估手术干预后无/部分/完全愈合方面，观察者之间的一致性很高。肩胛骨骨折的一致性更好。CT扫描对50%愈合的评估总体上具有中等程度的一致性。如果在手术治疗后12周或更晚的时间进行CT扫描，并对临床信息进行盲测，则可提高观察者之间和观察者内部的一致性。

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Inter- and Intraobserver Reliability for the Computed Tomography Scan Assessment of Union After Surgery for Scaphoid Fractures and Nonunion

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.