对解剖倾斜位X线平片判断桡骨远端螺钉穿破关节方法的评估

Evaluation of Anatomic Tilt X-Ray Films in Judging Intra-Articular Screw Penetration of Distal End of Radius

目的评估解剖倾斜位X线平片判断桡骨远端螺钉穿破关节方法的可靠性、可重复性和诊断价值。方法选择在标准正侧位X线平片显示可疑桡骨远端螺钉穿破关节的31例患者行腕关节CT扫描和解剖倾斜位X线平片检查。CT扫描螺钉位置作为标准,选择两位观察者依据解剖倾斜位X线平片,采用双盲法独立判断螺钉位置,计算判断的敏感性、特异性和预估值;采用Kappa系数计算一致性。结果 CT扫描未穿破17例,穿破14例。两位观察者首次判断螺钉未穿破的敏感性分别为94.12%和88.24%,特异性分别为87.50%和93.33%,预估值均为100%;判断螺钉穿破的敏感性分别为93.33%和87.50%,特异性分别为106.25%和93.75%,预估值分别为93.33%和87.50%。两位观察者之间的Kappa系数为0.81-0.94,具有高度可靠性;二次重复判断之间的Kappa系数均为0.87,具有高度可重复性。结论解剖倾斜位X线平片判断桡骨远端螺钉穿破关节具有高度的可靠性、可重复性和较高的诊断价值。

Objective To evaluate the reliability, repeatability and diagnostic value of anatomic tilt X-ray films in judging intra-articular screw penetration of distal end of radius. Methods A total of 31 patients, in whom the distal radius screws were suspected to penetrate into the joint on standard AP and lateral films, were enrolled in this study. CT scanning and anatomic tilt X-ray films of the wrist joint were performed in all the patients. Taking the screw position displayed on CT scans as the reference standard and using double-blind method, the anatomic tilt X-ray films of the wrist joint were independently analyzed by two radiologists to judge the screw position. The sensitivity, specificity and predictive value were calculated, and the consistency between two radiologists was evaluated using Kappa coefficient analysis. Results CT scans indicated that no intra-articular screw penetration was detected in 17 cases and intra-articular screw penetration was observed in 14 cases. The sensitivity, specificity and predictive value for the absence of intra-articular screw penetration judged by two radiologists were 94.12% and 87.50% ; 87.50% and 93.33% ; 100% and 100% respectively, while the sensitivity, specificity and predictive value for the presence of intra-articular screw penetration judged by two radiologists were 93.33% and 87.50% ; 106.25% and 93.75% ; 93.33% and 87.50% respectively. The intraobserver Kappa coefficient of initial judgment was 0.81 -0.94, indicating the presence of a higher reliability. The intra-observer Kappa coefficient of second judgment was 0.87, indicating the presence of higher repeatability. Conclusion Anatomic tilt X-ray films has higher reliability and repeatability in judging the presence or absence of intra-articular screw penetration, therefore it has great diagnostic value.