基于肩关节骨性关节盂后下部最大拟合圆采用径线缺损比例法评价关节盂形态的可靠性研究

The Reliability of Evaluating Shoulder Glenoid Cavity by Loss Diameter Ratio Based on Maximum Fitting Circle of Bottom Back Part of Glenoid Rim

目的:评估基于肩关节骨性关节盂后下部最大拟合圆的关节盂形态评价方法的可靠性,为提高临床工作及相关研究的准确性提供依据。方法:入组人群为成年人,无肩关节脱位病史,无肩关节畸形等其他可能导致关节盂形态异常的因素。共40例患者(80例关节盂)纳入本研究。入组人群因非脱位导致的肩关节不适进行包含双侧肩关节盂的CT检查。对层厚、层间距为1 mm的关节盂图像进行VR重建,旋转至En-face位。对图像采用径线缺损比例法进行评价。3位资历不同的医师基于关节盂后下部绘制拟合圆,测量并记录拟合圆的半径(R)、关节盂前缘距圆心最近点的距离(D),计算径线缺损量与拟合圆直径之比[F=(R-D)/2R*100%]。测量3次取平均值作为该测量者该次关节盂测量结果。上述测量共进行2次,测量间隔3个月以上。采用组内相关系数分析比较同一医师不同次测量及各医师间测量结果的差异,ICC值大于0.75认为可靠性良好,ICC值小于0.4认为可靠性不佳,ICC值介于0.4与0.75之间认为可靠性一般。结果:共40名患者(80个关节盂)纳入研究。采用组内相关系数分析,每名医师不同次测量中各参数ICC大于0.9,可靠性好;各医师间测量结果R、D的ICC值介于0.4至0.75之间,可靠性一般;F的ICC值小于0.2,可靠性不佳。结论:基于关节盂后下部最大拟合圆采用径线缺损比例法评价关节盂形态这一方法,同一测量者测量可重复性好,但测量者间可靠性不佳。可采用多名测量者测量并求取均值方案以保证结果的可信度。通过测量径线缺损比例的方法不能真实准确地反映关节盂缺损情况,在临床工作及研究中应谨慎使用。

Objective To evaluate the reliability of evaluating the shape of the shoulder glenoid cavity based on the maximal fitting circle of the bottom back part of the glenoid rim, so as to provide evidences to improve the accuracy in clinical practice and related research. Methods Forty patients with shoulder joint discomfort, but without history of shoulder joint dislocation, deformity or other factors that could lead to abnormal shapes of the glenoid, were selected. All subjects were given CT scan for both shoulders. For glenoid cavity images with the layer thickness and layer spacing of 1mm, the virtual reality(VR) reconstruction was conducted and the glenoid cavities were rotated to the En-face position. The images were evaluated using the method of loss diameter ratio. The maximal fitting circle of the bottom back part of the glenoid rim was drawn by three physicians with different experiences, with the radius of the circle(R) and distance from the nearest point of glenoid rim to the center of circle(D) recorded, as well as the ratio of distance between the loss of diameter to the (liameter[F=(R-D)/2R* 100%] calculated. This process was conducted 3 times to get the average values, and repeated once more more than 3 months later. Interclass correlation coefficient (ICC) of R, I) cind F was calculated between different results of each physician and among different physicians. ICC larger than 0.75 suggested good reliability, while ICC less tluin 0.4 suggested poor reliability. ICC between 0.4 and 0.75 suggested common reliability. Results Totally 40 patients with 80 glenoid cavities were involved. The reliability test based on ICC showed good reliability of R, I) and F between different results of each physician with ICCs larger than 0.9.ICC of R and I) among different physicians were between 0.4 and 0.75, which suggested common repeatability. ICC of F was less than 0.1 . which indicated very poor reliability. Conclusion The reliability of evaluating glenoid cavity by the defected diameter based on the maximal fitting circle of the bottom back part of the glenoid rim is good for the same physician, but poor among different ones. Therefore, the credibility can be guti ran teed by measuring repeatedly to get the average. The ratio of distance between the anterior part of the glenoid rim and anterior part of the circle to diameter of the circle can not evaluate the defect of the glenoid cavity in bony Bankart lesion accurately and actually,and should be used prudently in clinical practice and seiirch.