肩盂骨缺损的评估：缺损面积百分比与缺损宽度百分比实际测量的对比研究

The Assessment of Glenoid Bone Defect: The Comparison of Relative Glenoid Defect Area with Relative Defect Width

目的:通过比较肩盂骨缺损面积百分比和缺损宽度百分比之间的差别以及观察者之间测量一致性的对比,为临床医生提供更准确的缺损评估参考。方法:2016年3月到2017年1月,将我院运动损伤科手术治疗的复发性肩关节前脱位69例患者纳入本研究,三位主治医师分别测量其肩盂缺损宽度百分比和缺损面积百分比,间隔3月后再次测量,用组内相关系数(intraclass correlation coefficient,ICC)评价测量的一致性。根据第一次测量的平均缺损宽度百分比将患者分为四组,分别是5%~10%、10%~15%、15%~20%、20%~25%,用方差分析比较各组之间缺损面积百分比和缺损宽度百分比的平均差值。结果:观察者之间(inter-observer)缺损面积百分比测量ICC是(0.557,0.513),缺损宽度百分比测量ICC是(0.446,0.374)。同一观察者两次(intra-observer)缺损面积百分比测量ICC在0.585~0.713之间,同一观察者两次缺损宽度百分比测量ICC在0.523~0.666之间。取第一次测量三位观察者的平均值进行分析,平均缺损宽度百分比从6.5%到21.4%,四组缺损宽度百分比和缺损面积百分比差值的平均值不全相等(P=0.003)。缺损宽度百分比平均比缺损面积百分比大4.67%,其中第一组平均大3.54%,第二组和第三组平均大5.02%和4.64%,第四组平均大4.66%。第一组和第二组、第一组和第三组有显著性差别,而第二组、第三组、第四组之间无显著性差别。结论:对于肩关节前方不稳定患者的肩盂缺损评估,缺损面积百分比测量的一致性好于按缺损宽度百分比的测量,同一观察者两次测量的一致性好于不同观察者测量之间的一致性。缺损宽度百分比的评估平均比按缺损面积百分比的评估高4.67%。缺损宽度百分比在10%以上时,这种差别更显著。

Objective To provide more accurate assessment on anterior glenoid defect through the com parison of the relative glenoid defect area with defect width.Methods Between May 2013 and January 2017,69 patients with recurrent anterior shoulder instability underwent surgical procedure in our de partment were enrolled for the study.The percentages of glenoid linear defect and areal defect were measured by three attending doctors.The measurement was repeated with an interval of three months.Intraclass correlation coefficient(ICC)was used to assess the reliability of the measurement.The pa tients were divided into four groups in terms of the average of first linear measurements,which were 5%~10%(A),10%~15%(B),15%~20%(C)and 20%~25%(D)groups.The one-way ANOVA was used to analyze the average percentages of areal defect and linear defect respectively among groups.Results The inter-observer ICCs of percentages of the areal and linear defect were 0.557 and 0.513,0.446 and 0.374 respectively,while the intra-observer ICCs of percentages of the areal defect and linear defect were between 0.585 and 0.713,as well as between 0.523 and 0.666 respectively.The average values of first measurements were used to make analysis.The average percentages of the linear defect ranged from 6.5%to 21.4%.The percentage of linear defect was 4.67%higher than the percentage of areal defect averagely.The gap was 3.54%,5.02%,4.64%and 4.66%in group A,B,C and D,showing significant differences between group A and C,as well group A and D,but nota mong group B,C and D.Conclusions The reliability of relative areal defect measurement is superior to that of relative linear defect measurement.The intra-observer ICCs is higher than the inter-observer ones.The percentage of linear defect is 4.67%higher than that of areal defect averagely,which is more significant when the percentage of linear defect over 10%.