三维CT测量肩关节复发前脱位肩胛盂轨迹的可靠性研究  

Reliability of three-dimensional CT measurement of glenoid track in patients with recurrent anterior dislocation of shoulder

作　　者：代飞 杨金松 张清[1] 陈君蓉[2] 向明[1] DAI Fei;YANG Jin-song;ZHANG Qing;CHEN Jun-rong;XIANG Ming(Department of Upper Limb,Sichuan Provincial Orthopaedic Hospital,Chengdu 610041,Sichuan,China)

机构地区：[1]四川省骨科医院上肢科,四川成都610041 [2]四川省骨科医院放射科,四川成都610041

出　　处：《中国骨伤》2021年第6期492-496,共5页China Journal of Orthopaedics and Traumatology

基　　金：四川省卫生健康委员会科研课题(编号:19PJ258)。

摘　　要：目的:本研究旨在评估三维CT测量肩盂轨迹的可靠性和可重复性。方法:由3位独立观察者(肩关节专科医生)通过三维CT评估60例单侧肩关节复发前脱位患者的肩胛盂及Hill-Sachs骨缺损情况,并按Di Giacomo等的方法,将损伤分类,制定手术方案。所有观察者在1周后重复测量。采用组内相关系数(intraclass correlation coefficient,ICC)及变异系数(coefficient of variation,COV)进行可靠性分析。结果:在肩胛盂直径及肩胛盂骨缺损的测量中,观察者间的可靠性均为“非常好”,对Hill-Sachs间隙的测量,观察者间的可靠性为“好”;在肩胛盂缺损程度的评估上观察者间的一致性很高,在Hill-Sachs损伤on-track/off-track的评估上观察者间的一致性较差。肩胛盂直径、肩胛盂骨缺损、Hill-Sachs间隙测量观察者内的可靠性均为“非常好”。肩胛盂直径、肩胛盂骨缺损的COV分别为4.1%和4.4%,Hill-Sachs间隙的COV为21.1%。结论:三维CT测量肩胛盂骨缺损的可靠性、可重复性高,但对肱骨头骨缺损的评估显示出较大的可变性,可靠性较差。Objective:To evaluate the reliability and repeatability of three-dimensional(3D)-CT measurement of glenoid track.Methods:Glenoid and Hill-Sachs bone defects in 60 patients with recurrent anterior dislocation of the unilateral shoulder were evaluated by 3D-CT and analyzed by three independent observers(shoulder orthopedists)according to the Di Giacomo method.These injuries were classified to formulate a surgical protocol.All the patients were repeatedly measured 1 week later.Intraclass correlation coefficient(ICC)and coefficient of variation(COV)were used for reliability analysis.Results:Interobserver reliability was"very good"for both measurements of glenoid diameter and glenoid bone defects,and"good"for measurements of Hill-Sachs interval.Interobserver agreement was high on the assessment of the extent of the glenoid defect,and poor on track/off track assessment of the Hill-Sachs lesion.Intraobserver reliability for measurements of glenoid diameter,glenoid defect,and Hill-Sachs interval was"very good".The COV was 4.1%for glenoid diameter,4.4%for glenoid defect,and 21.1%for Hill-Sachs interval.Conclusion:The reliability and reproducibility of 3D-CT measurements of glenoid bone defects are good,but the assessment of humeral head bone defects shows large variability with poor reliability.

关 键 词：肩关节 肩脱位 肩盂轨迹 成像 三维 

分 类 号：R684[医药卫生—骨科学]