Comparison of fixed-flexion positioning with fluoroscopic semi-flexed positioning for quantifying radiographic joint-space width in the knee: test-retest reproducibility
Comparison of fixed-flexion positioning with fluoroscopic semi-flexed positioning for quantifying radiographic joint-space width in the knee: test-retest reproducibility
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DOI：
10.1007/s00256-002-0603-z
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发表时间：
2003-03-01
影响因子：
2.1
通讯作者：
Genant, HK
中科院分区：
文献类型：
--
作者：
Peterfy, C;Li, J;Genant, HK
目的：比较膝关节固定屈曲X线摄影与透视半屈曲X线摄影测量内侧股胫关节最小关节间隙宽度（JSW）的可重复性。研究方法：18名正常志愿者，站在垂直透视台上，双足外旋100 °，足尖接触垂直透视台，拍摄右膝后前位X线片。采用两种不同的技术对膝关节进行定位和X线摄影：（1）在X线透视引导下使用水平X线束进行半屈曲定位;（2）固定屈曲定位，膝关节和大腿接触垂直工作台，使用10度尾侧射束成角，无需X线透视。在每种情况下都绘制了足迹图。使用每种技术重新定位受试者并进行两次X线摄影。在使用X线透视的单独检查中，还确定了每例受试者在固定屈曲位时最佳投影内侧胫骨平台的后前位射束角。10例骨关节炎患者也进行了检查与固定屈曲技术，使用传统的X线摄影单位。内侧股胫关节的最小内侧关节间隙宽度（JSW）用刻度透镜手动测量，也用半自动计算机算法测量。结果如下：对于志愿者的透视半屈曲定位，手动和自动JSW测量的再现误差（均方根SD）分别为0.2 mm和0.1 mm;对于志愿者的固定屈曲定位，分别为0.3 mm和0.1 mm;对于骨关节炎患者的固定屈曲定位，分别为0.2 mm和0.1 mm。关节间隙可视化的最佳光束角度为9.0度+/-3.6度。结论：使用广泛使用的X线设备，膝关节固定屈曲、非透视X线摄影可提供可重复的JSW测量。该技术对于多中心临床研究和常规临床使用比依赖于胫骨平台X线透视对线的方法更可行。
Objective: To compare fixed-flexion radiography of the knee with fluoroscopic semi-flexed radiography in terms of the reproducibility of measurements of minimum joint-space width (JSW) in the medial femorotibial joint. Methods: Posteroanterior radiographs of the right knees of 18 normal volunteers were acquired with the patients standing on an upright fluoroscopy table, the feet externally rotated 10degrees and the toes touching the vertical table. Knees were positioned and radiographed with two different techniques: (1) semi-flexed positioning under fluoroscopic guidance using a horizontal X-ray beam; and (2) fixed-flexion positioning, with the knees and thighs touching the vertical table, using 10degrees caudal beam angulation without fluoroscopy. Foot maps were drawn in each case. Subjects were repositioned and radiographed twice using each technique. The posteroanterior beam angle that optimally projected the medial tibia plateau with the patient in the fixed-flexion position was also determined for each subject in a separate examination using fluoroscopy. Ten patients with osteoarthritis were also examined with the fixed-flexion technique using a conventional radiographic unit. Minimum medial joint-space width (JSW) in the medial femorotibial joint was measured manually with a graduated lens and also with a semi-automated computer algorithm. Results: Reproducibility errors (root-mean-square SD) for manual and automated JSW measurement were 0.2 mm and 0.1 mm, respectively, for fluoroscopic semi-flexed positioning in volunteers; 0.3 mm and 0.1 mm, respectively, for fixed-flexion positioning in volunteers; and 0.2 mm and 0.1 mm, respectively, for fixed-flexion positioning in osteoarthritic patients. The optimal beam angle for visualizing the joint space was 9.0degrees+/-3.6degrees. Conclusion: Fixed-flexion, non-fluoroscopic radiography of the knee can provide reproducible JSW measurement using widely available X-ray equipment. This technique is more feasible for multicenter clinical studies and routine clinical use than are methods that rely on fluoroscopic alignment of the tibial plateau.