CT与MRI评估Hill-Sachs损伤可靠性的对比观察

Comparative study on reliability of CT and MRI in evaluating Hill Sachs lesions

目的比较肩关节不稳患者Hill-Sachs损伤CT和MRI测量的可靠性。方法2020年1月到2020年9月四川省骨科医院上肢科手术治疗的复发性肩关节前脱位患者25例。由3位独立观察者(2位经验丰富,1位无测量经验)通过2D-CT、3D-CT以及MRI评估拟行手术治疗复发性肩关节前脱位患者的Hill-Sachs损伤。所有观察者在1周后重复测量。采用组内相关系数(ICC)进行CT及MRI的可靠性统计分析。结果有经验的观察者间3D-CT的可靠性为中等或好(ICC=0.490,0,658),2D-CT和MRI可靠性差。有经验与无经验的观察者相比,在2D-CT和MRI中的测量可靠性均较差,在3D-CT测量中可靠性为中等(ICC=0.472,0.503)。观察者内的可靠性在3D-CT重复测量的可靠性为好或非常好(ICC=0.892,0.734,0.895);2D-CT重复测量的可靠性为好或可(ICC=0.646,0.760,0.267);MRI重复测量的可靠性为中等或差。结论对于Hill-Sachs损伤的评估,3D-CT测量比2D-CT和MRI更可靠。2D-CT以及MRI的测量值易受测量层面的选择影响;3D-CT对于缺乏评估经验的测量者而言更易于掌握,准确度更高。

Objective To compare the reliability of CT and MRI measurement of Hill-Sachs lesions in recurrent anterior shoulder dislocation.Methods From January 2020 to September 2020,Hill-Sachs lesions of 25 patients with recurrent anterior shoulder dislocation were evaluated by 2D-CT,3D-CT and MRI by three independent observers(two experienced and one without measurement experience)in Department of Upper Limb,Sichuan Provincial Orthopaedic Hospital.All observers repeated the measurement after 1 week.The intra-class correlation coefficient(ICC)was used to analyze the reliability of CT and MRI.Results Among experienced observers,3D-CT inter-observer reliability;ICC values were moderate or good(ICC=0.490,0658);2D-CT and MRI ICC values were poor.The inter-observer reliability in both 2D-CT and MRI were poor compared with inexperienced observers and were moderate in 3D-CT measurements(ICC=0.472,0.503).For repeated measurements of 3D-CT,the intra-observer reliability were good or very good(ICC=0.892,0.734,0.895).For repeated 2D-CT measurements,the intra-observer reliability were good or acceptable(ICC=0.646,0.760,0.267);whereas the reliability of MRI were moderate or poor.Conclusion For Hill-Sachs lesions assessment,3D-CT measurements are more reliable than 2D-CT and MRI.Measurements of 2D-CT and MRI are susceptible to the setting of measurement plane.3D-CT is easier to operate and more accurate for the measurers who lack experience in evaluation.