Reliability of Intraoperative 3D-Fluoroscopic Imaging in Assessing Acetabular Fracture Reduction.

IF 1.8 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma Pub Date : 2025-09-29 DOI:10.1097/BOT.0000000000003091

Javier Guerrero, Aziz Saade, Margaret Hankins, Cody L Walters, Ruben Tresgallo Pares, Samuel K Simister, Shannon Tse, Rahul Bhale, Gillian L Soles, Ellen Fitzpatrick, Sean T Campbell, Mark A Lee, Augustine M Saiz

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引用次数: 0

Abstract

Objectives: To assess image quality and reliability of intraoperative 3D fluoroscopy in assessing acetabular reduction.

Methods: Design: Retrospective chart review.

Setting: Academic, level 1 trauma center.

Patient selection criteria: Adult patients with acetabular fractures involving weight-bearing dome and/or posterior wall (OTA/AO 62A, 62B, 62C) between 2017-2023 with intraoperative 3D fluoroscopy and postoperative computed tomography (CT) included.

Outcome measures and comparisons: Gap and step-off measurements made on intraoperative 3D fluoroscopy and postoperative CT by two graders using standardized technique. Assessments of image quality made using a scale of 1 (uninterpretable) to 5 (excellent). Interclass correlation coefficients (ICC) used to compare 3D fluoroscopy to CT and assessed intra/interobserver reliability for 3D fluoroscopy and CT images. Appropriate tests of significance performed.

Results: 54 patients with mean age of 48.4 ± 21.0 included. 72.2% of patients were male. 56/106 (52.8%) 3D fluoroscopic scans rated as 1/5 or 2/5. All CT images rated 3/5 or higher (p<0.001). 70% of CT measurements made with high confidence while 2.8% of 3D fluoroscopy measurements received this rating (p<0.001). Moderate agreement for gap (ICC=0.518, p<0.01) and step-off (ICC=0.420, p<0.01) when comparing 3D fluoroscopy to CT. CT showed good intra-reliability (ICC=0.747, 0.864; p<0.001) while 3D fluoroscopy showed moderate intra-reliability (ICC=0.638, 0.604; p<0.001). CT showed greater inter-reliability for largest gap (ICC 0.621, p<0.001) compared to fluoroscopy (ICC 0.219, p=0.05).

Conclusions: When assessing acetabular fracture reduction involving the weight-bearing dome and/or posterior wall, intraoperative 3D fluoroscopy performed worse than postoperative CT on measures of image quality and confidence in reduction assessment. 3D fluoroscopy showed poor ICC across all views compared to CT and performed worse for interrater reliability. 3D fluoroscopy has limitations when making final acetabular reduction assessments; it may be advisable to acquire postoperative CT.

Level of evidence: Level III, diagnostic.

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术中3d透视成像评估髋臼骨折复位的可靠性。

目的：评价术中三维透视评估髋臼复位的图像质量和可靠性。方法：设计：回顾性图表回顾。环境：学术，一级创伤中心。患者选择标准：纳入2017-2023年间伴有承重穹顶和/或后壁髋臼骨折（OTA/AO 62A, 62B, 62C）的成人患者，术中3D透视和术后CT检查。结果测量和比较：由两名分级者采用标准化技术对术中3D透视和术后CT进行间隙和间隙测量。使用1（不可解释）到5（优秀）的等级对图像质量进行评估。类间相关系数（ICC）用于比较3D透视和CT，并评估3D透视和CT图像的内部/观察者之间的可靠性。进行了适当的显著性检验。结果：54例患者，平均年龄48.4±21.0岁。72.2%为男性。56/106（52.8%）三维透视扫描评分为1/5或2/5。结论：在评估髋臼骨折负重穹窿和/或后壁复位时，术中3D透视在图像质量和复位评估的置信度方面不如术后CT。与CT相比，3D透视在所有视图上显示较差的ICC，并且在图像间可靠性方面表现较差。三维透视在髋臼复位评估时存在局限性；术后行CT检查为宜。证据等级：III级诊断。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Orthopaedic Trauma 医学-运动科学

CiteScore

3.90

自引率

8.70%

发文量

396

审稿时长

3-8 weeks

期刊介绍： Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.