Background:

Preoperative quantification of bone loss has a significant effect on surgical decision making and patient outcomes. Various measurement techniques for calculating glenoid bone loss have been proposed in the literature. To date, no studies have directly compared measurement techniques to determine which technique, if any, is the most reliable.

Purpose/Hypothesis:

To identify the most consistent and accurate techniques for measuring glenoid bone loss in anterior glenohumeral instability. Our hypothesis was that linear measurement techniques would have lower consistency and accuracy than surface area and statistical shape model–based measurement techniques.

Study Design:

Controlled laboratory study.

Methods:

In 6 fresh-frozen human shoulders, 3 incremental bone defects were sequentially created resulting in a total of 18 glenoid bone defect samples. Analysis was conducted using 2D and 3D computed tomography (CT) en face images. A total of 6 observers (3 experienced and 3 with less experience) measured the bone defect of all samples with Horos imaging software using 5 common methods. The methods included 2 linear techniques (Shaha, Griffith), 2 surface techniques (Barchilon, PICO), and 1 statistical shape model formula (Giles). Intraclass correlation (ICC) using a consistency model was used to determine consistency between observers for each of the measurement methods. Paired t tests were used to calculate the accuracy of each measurement technique relative to physical measurement.

Results:

For the more experienced observers, all methods indicated good consistency (ICC > 0.75; range, 0.75-0.88), except the Shaha method, which indicated moderate consistency (0.65 < ICC < 0.75; range, 0.65-0.74). Estimated consistency among the experienced observers was better for 2D than 3D images, although the differences were not significant (intervals contained 0). For less experienced observers, the Giles method in 2D had the highest estimated consistency (ICC, 0.88; 95% CI, 0.76-0.95), although Giles, Barchilon, Griffith, and PICO methods were not statistically different. Among less experienced observers, the 2D images using Barchilon and Giles methods had significantly higher consistency than the 3D images. Regarding accuracy, most of the methods statistically overestimated the actual physical measurements by a small amount (mean within 5%). The smallest bias was observed for the 2D Barchilon measurements, and the largest differences were observed for Giles and Griffith methods for both observer types.

Conclusion:

Glenoid bone loss calculation presents variability depending on the measurement technique, with different consistencies and accuracies. We recommend use of the Barchilon method by surgeons who frequently measure glenoid bone loss, because this method presents the best combined consistency and accuracy. However, for surgeons who measure glenoid bone loss occasionally, the most consistent method is the Giles method, although an adjustment for the overestimation bias may be required.

Clinical Relevance:

The Barchilon method for measuring bone loss has the best combined consistency and accuracy for surgeons who frequently measure bone loss.

中文翻译：

---

测量前盂肱关节不稳中关节盂骨丢失的最可靠方法是什么？比较关节盂骨丢失的不同测量技术的尸体研究

背景：

骨丢失的术前量化对手术决策和患者结果有显着影响。文献中已经提出了用于计算关节盂骨丢失的各种测量技术。迄今为止，还没有研究直接比较测量技术以确定哪种技术（如果有的话）是最可靠的。

目的/假设：

确定最一致和准确的技术来测量前盂肱关节不稳的关节盂骨丢失。我们的假设是线性测量技术的一致性和准确性低于基于表面积和统计形状模型的测量技术。

学习规划：

受控实验室研究。

方法：

在 6 个新鲜冷冻的人肩中，依次产生 3 个增量骨缺损，导致总共 18 个关节盂骨缺损样本。使用 2D 和 3D 计算机断层扫描 (CT) 面部图像进行分析。共有 6 名观察员（3 名经验丰富，3 名经验较少）使用 Horos 成像软件使用 5 种常用方法测量所有样本的骨缺损。这些方法包括 2 种线性技术（Shaha、Griffith）、2 种表面技术（Barchilon、PICO）和 1 种统计形状模型公式（Giles）。使用一致性模型的类内相关性 (ICC) 用于确定每种测量方法的观察者之间的一致性。配对t检验用于计算每种测量技术相对于物理测量的准确性。

结果：

对于更有经验的观察者，所有方法都表明一致性良好（ICC > 0.75；范围，0.75-0.88），但 Shaha 方法除外，它表明一致性中等（0.65 < ICC < 0.75；范围，0.65-0.74）。经验丰富的观察者之间的估计一致性对于 2D 图像比 3D 图像更好，尽管差异并不显着（间隔包含 0）。对于经验不足的观察者，二维 Giles 方法具有最高的估计一致性（ICC，0.88；95% CI，0.76-0.95），尽管 Giles、Barchilon、Griffith 和 PICO 方法在统计学上没有差异。在经验不足的观察者中，使用 Barchilon 和 Giles 方法的 2D 图像的一致性明显高于 3D 图像。关于准确性，大多数方法在统计上都略微高估了实际物理测量值（平均在 5% 以内）。对于 2D Barchilon 测量观察到的偏差最小，对于两种观察者类型，Giles 和 Griffith 方法观察到的差异最大。

结论：

关节盂骨质流失计算根据测量技术呈现出可变性，具有不同的一致性和准确性。我们建议经常测量关节盂骨丢失的外科医生使用 Barchilon 方法，因为这种方法具有最佳的一致性和准确性。然而，对于偶尔测量关节盂骨丢失的外科医生来说，最一致的方法是 Giles 方法，尽管可能需要对高估偏差进行调整。

临床相关性：

对于经常测量骨质流失的外科医生，用于测量骨质流失的 Barchilon 方法具有最佳的综合一致性和准确性。