在全膝关节置换术中应用膝关节负荷装置评估胫骨构件松动时操作人员的差异

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-04-16 DOI:10.1016/j.clinbiomech.2025.106531

George S. Buijs , Maaike A. ter Wee , Chiel Klein , Lidwine B. Mokkink , Johannes G.G. Dobbe , Mario Maas , Matthias U. Schafroth , Geert J. Streekstra , Leendert Blankevoort , Arthur J. Kievit

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引用次数: 0

摘要

背景：一种基于ct的方法已经被开发出来，通过在加载装置中扫描膝关节来帮助诊断胫骨部件的无菌性松动，随后的3d图像分析来量化部件的位移。本研究使用两种图像分析方案，评估了在应用加载装置时操作人员差异对组件位移变量的影响。方法16例患者反复进行外翻、内翻负荷CT检查。两名操作人员对每名患者使用装载装置。每次加载时，进行CT扫描，胫骨组件相对于胫骨的位移被量化为围绕螺钉轴的旋转，最大总点运动和平均目标配准误差。采用两种方案：(1)分析整个胫骨（100%）和(2)胫骨近端（20%）以减轻胫骨变形。使用类内相关系数（ICCagreement）、测量标准误差、操作人员标准误差和最小可检测变化来评估操作人员间的可靠性和测量误差。结果：100%胫骨方案显示中度至良好的icc一致性（不同位移变量为0.64 - 0.84），测量标准误差约为0.15 mm或度。20%胫骨方案显示较差至中度的icc一致性，范围为0.17至0.31，测量标准误差约为0.10 mm或度。该方案显示较小的测量误差，但较差的icca一致性，这是由于较小的表观种植体位移减少了受试者方差。与操作者相关的误差在统计学和临床上都可以忽略不计。最小的可检测变化值在0.27到0.44毫米或度之间。100%胫骨方案显示中等到良好的可靠性，而20%方案降低了可靠性，但降低了测量误差。证据等级：II级。

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Operator variation in applying a knee loading device for evaluation of tibial component loosening in total knee arthroplasty

Background

A CT-based method has been developed to aid diagnosis of aseptic loosening of the tibial component by scanning the knee in a loading device, and subsequent 3D-image analysis to quantify component displacement. This study evaluated the effect of operator differences in applying the loading device on the component displacement variables, using two image analysis protocols.

Methods

Sixteen subjects underwent repeated CT examinations with valgus and varus loading. Two operators applied the loading device to each patient. With each load, a CT scan was made, and tibial component displacement relative to the tibia was quantified as rotation about the screw-axis, Maximum Total Point Motion and mean Target Registration Error. Two protocols were used: (1) analyzing the entire tibia (100 %) and (2) the proximal tibia (20 %) to mitigate tibia deformation. Inter-operator reliability and measurement error were assessed using intraclass correlation coefficient (ICC_agreement), standard error of measurement, standard error of operator and smallest detectable change.

Findings

The 100 % tibia protocol showed moderate-to-good ICC_agreement(0.64– 0.84 for the different displacement variables) with standard error of measurement around 0.15 mm or degree. The 20 % tibia protocol showed poor-to-moderate ICC_agreement, ranging from 0.17 to 0.31, with the standard error of measurement around 0.10 mm or degree. This protocol showed smaller measurement errors but poorer ICC_agreement due to reduced subject variance explained by smaller apparent implant displacements. Operator related error was statistically and clinically negligible. The smallest detectable change values ranged between 0.27 and 0.44 mm or degree.

Interpretation

The 100 % tibia protocol showed moderate-to-good reliability, whereas the 20 % protocol reduced reliability but lower measurement error.

Level of evidence

Level II.

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.