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Accuracy and Reliability of the Visual Assessment of Patellar Tracking.

髌骨跟踪视觉评估的准确性和可靠性。

  • 影响因子:6.02
  • DOI:10.1177/0363546519895246
  • 作者列表:"Best MJ","Tanaka MJ","Demehri S","Cosgarea AJ
  • 发表时间:2020-02-01
Abstract

BACKGROUND:Abnormal patellar tracking is described as a "J-sign" when the patella exhibits excessive lateral displacement during active knee extension. PURPOSE:To determine (1) the accuracy and reliability of the visual assessment of patellar tracking when viewed by surgeons with patellofemoral expertise and (2) whether surgeon experience (in years) correlates with the ability to accurately identify the presence and severity of patellar maltracking. STUDY DESIGN:Cohort study (diagnosis); Level of evidence, 2. METHODS:Using a web-based assessment, 32 orthopaedic surgeon members of the International Patellofemoral Study Group determined the presence or absence of maltracking (≥2 quadrants of lateral translation) in 10 single-knee videos of patients with patellar instability during active knee extension (qualitative analysis). Surgeons then graded patellar tracking in 20 single-knee videos as follows: 0 (<1 patellar quadrant of lateral translation), 1 (1 to <2 quadrants), 2 (2 to <3 quadrants), or 3 (≥3 quadrants) (quantitative analysis). Responses were compared with a previously described grading system using patellar bisect offset measured with 4-dimensional computed tomography. We evaluated the association between number of years of surgeon experience and the ability to correctly identify and grade patellar tracking. A total of 22 surgeons repeated the survey 3 months later, and their answers were matched to the first survey, allowing for assessment of intraobserver reliability. RESULTS:In the qualitative analysis, surgeons correctly identified videos as showing patellar maltracking 68% of the time (κ = 0.45). In the quantitative analysis, 53%, 51%, 48%, and 68% of surgeons correctly identified maltracking of grades 3, 2, 1, and 0, respectively (κ = 0.42). Surgeon experience did not correlate with ability to identify the presence (P = .59) or grade (P = .35) of patellar maltracking. Respondent answers from the second survey demonstrated inadequate intraobserver reliability (κ = 0.48). CONCLUSION:Using visual assessment alone, surgeons correctly identified patellar maltracking in approximately two-thirds of videos and correctly graded patellar maltracking in half. Inter- and intraobserver reliability were inadequate to support the use of visual assessment alone for detecting the presence or grade of patellar maltracking. Surgeon experience did not correlate with ability to identify the presence or grade of patellar maltracking.

摘要

背景: 当髌骨在主动膝关节伸展过程中表现出过度的外侧移位时,异常髌骨跟踪被描述为 “J征”。 目的: 确定 (1) 由具有髌股专业知识的外科医生观察髌骨跟踪的视觉评估的准确性和可靠性,以及 (2) 外科医生经验 (以年计) 是否与准确识别髌骨跟踪不良的存在和严重程度的能力相关。 研究设计: 队列研究 (诊断); 证据水平,2. 方法: 使用基于网络的评估,国际髌股研究组的32名骨科医生成员在10个主动膝关节伸展期间髌骨不稳定患者的单膝关节视频中确定了是否存在错位 (≥ 2个外侧平移象限) (定性分析)。然后,外科医生在20个单膝视频中对髌骨跟踪进行分级,如下所示: 0 (外侧平移的髌骨象限 <1) 、1 (1至 <2象限) 、2 (2至 <3象限) 或3 (≥ 3象限) (定量分析)。使用4维计算机断层扫描测量的髌骨平分偏移,将反应与先前描述的分级系统进行比较。我们评估了外科医生经验的年数与正确识别和分级髌骨追踪的能力之间的关联。3个月后,共有22名外科医生重复了调查,他们的回答与第一次调查相匹配,从而评估了观察者内的可靠性。 结果: 在定性分析中,外科医生正确地将视频识别为68% 的时间显示髌骨异常 (κ = 0.45)。在定量分析中,分别有53% 、51% 、48% 和68% 的外科医生正确识别出3、2、1和0级的失访 (κ = 0.42)。外科医生的经验与确定髌骨畸形的存在 (P = .59) 或分级 (P = .35) 的能力无关。第二次调查的受访者回答显示观察者内可靠性不足 (κ = 0.48)。 结论: 单独使用视觉评估,外科医生在大约3分之2的视频中正确识别髌骨畸形,在一半中正确分级髌骨畸形。观察者间和观察者内的可靠性不足以支持单独使用视觉评估来检测髌骨畸形的存在或程度.外科医生的经验与确定髌骨畸形的存在或分级的能力无关。

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METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.

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