Jeong, Jaemin
(College of Veterinary Medicine, Chungnam National University)
,
Kim, Eunki
(College of Veterinary Medicine, Chungnam National University)
,
Jeong, Youngeun
(College of Veterinary Medicine, Chungnam National University)
,
Jeong, Seong Mok
(College of Veterinary Medicine, Chungnam National University)
,
Lee, Hae Beom
(College of Veterinary Medicine, Chungnam National University)
,
Kwon, Youngsam
(College of Veterinary Medicine, Kyungpook National University)
The purpose of this study was to establish normal values for the thoracic limb joint reference angles in Shih Tzu dogs and to describe the standardized CT methodology for measuring the joint reference angle of the humerus. Five pairs of thoracic limbs of Shih Tzu dogs were collected for the CT scans...
The purpose of this study was to establish normal values for the thoracic limb joint reference angles in Shih Tzu dogs and to describe the standardized CT methodology for measuring the joint reference angle of the humerus. Five pairs of thoracic limbs of Shih Tzu dogs were collected for the CT scans in this study. Three blinded observers measured the joint reference angle of the humerus and radius for each dog by using CT scans in the frontal, sagittal, and axial planes. The means (± SDs) for the average of the right and left humeral joint reference angles were as follows: mMPHA, 83.74 ± 3.95°; mLDHA, 85.04 ± 2.57°; mCaPHA, 46.75 ± 2.20°; mCrDHA, 79.47 ± 1.97°; and HTA, 19.16 ± 2.38°. Means (± SD) for the average of right and left of the radial joint reference angles were as follows: aMPRA, 85.04 ± 1.58°; aLDRA, 87.59 ± 1.37°; aCrPRA, 84.60 ± 1.46°; aCdDRA, 84.27 ± 1.79°; and RTA, 20.91 ± 3.00°. The intraclass correlation coefficients (ICCs) of the joint reference angles for the inter- and intraobserver reliability were good to excellent, except those for the mCrHA and HTA were moderate. Our results suggest that the method of measuring joint reference angles of other long bones by using CT can be applied to thoracic limbs and can extract valid values for one specific breed.
The purpose of this study was to establish normal values for the thoracic limb joint reference angles in Shih Tzu dogs and to describe the standardized CT methodology for measuring the joint reference angle of the humerus. Five pairs of thoracic limbs of Shih Tzu dogs were collected for the CT scans in this study. Three blinded observers measured the joint reference angle of the humerus and radius for each dog by using CT scans in the frontal, sagittal, and axial planes. The means (± SDs) for the average of the right and left humeral joint reference angles were as follows: mMPHA, 83.74 ± 3.95°; mLDHA, 85.04 ± 2.57°; mCaPHA, 46.75 ± 2.20°; mCrDHA, 79.47 ± 1.97°; and HTA, 19.16 ± 2.38°. Means (± SD) for the average of right and left of the radial joint reference angles were as follows: aMPRA, 85.04 ± 1.58°; aLDRA, 87.59 ± 1.37°; aCrPRA, 84.60 ± 1.46°; aCdDRA, 84.27 ± 1.79°; and RTA, 20.91 ± 3.00°. The intraclass correlation coefficients (ICCs) of the joint reference angles for the inter- and intraobserver reliability were good to excellent, except those for the mCrHA and HTA were moderate. Our results suggest that the method of measuring joint reference angles of other long bones by using CT can be applied to thoracic limbs and can extract valid values for one specific breed.
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제안 방법
CT scan images were produced by a 16-slice helical CT scanner using a 1 mm slice thickness with 50% overlap (Aquilion, Toshiba, Japan). Multiplanar reconstruction (MPR) was implemented, and each humerus and radius were adjusted in the frontal, sagittal and axial planes based on landmarks.
The CT measurement techniques used in this study demonstrated good to excellent reliability for the radius and moderate to excellent reliability for the humerus in normal Shih Tzu dogs. Surface landmarks for the thoracic limbs were easy to identify in all 3 planes, and all the investigators were able to attain consistent results for the measurements with three times of training. Additionally, the intraobserver reliability for the humerus was excellent for all the angles, and the interobserver reliability for the humerus was excellent in the frontal plane and moderate to good in the sagittal and axial planes.
The current study focused on establishing the reference joint angle value of the thoracic limb in the Shih Tzu dog breed by assessing CT images. The reference values of the radial joint angles were obtained by methods used by other authors (9,14,16), and the measurement method of the humeral joint angle using CT was developed based on previous radiographic methodology (7).
The evaluation of the intra- and interobserver reliability of the CT measurement method for the humeral and radial joint reference angles was performed with intraclass correlation coefficients (ICCs) and 95% CIs. The interpretation of the ICC was made according to the criteria of Portney and Watkins: poor reliability is indicated by values less than 0.
Anesthesia was induced with propofol (2-6 mg/kg) and maintained via inhalation of isoflurane (2%) with 100% oxygen. The patients were positioned in sternal recumbency with cranial extension of both forelimbs, allowing the carpal, elbow and shoulder joints to lie in their neutral positions. CT scan images were produced by a 16-slice helical CT scanner using a 1 mm slice thickness with 50% overlap (Aquilion, Toshiba, Japan).
The joint reference angle of the humerus and radius for each dog were measured by using CT scans of the frontal, sagittal, and axial planes. The primary investigator (EK) instructed two blinded observers (JM, YE) during the trial of 5 normal limbs to ensure consistent measurement. To assess the interobserver reliability, each set of CT images was reviewed in a single session by three blinded investigators (EK, JM, YE).
The present study was based on Shih Tzu dogs, as they are one of the most common chondrodystrophic dog breeds. The purposes of the study were (1) to report normal values of the joint reference angles in the frontal, sagittal, and axial planes for thoracic limbs in a single breed of Shih Tzu dogs and (2) to describe the standardized method for measuring the joint reference angle of the humerus by Computed tomography (CT). Our hypothesis was that CT methods previously reported for the other long bones can be applied to the entire thoracic limb and can extract valid values for the joint reference angles for one specific breed.
The primary investigator (EK) instructed two blinded observers (JM, YE) during the trial of 5 normal limbs to ensure consistent measurement. To assess the interobserver reliability, each set of CT images was reviewed in a single session by three blinded investigators (EK, JM, YE). To determine the intraobserver reliability, the primary investigator repeated the measurements 3 times within a one-week interval.
대상 데이터
CT data of five Shih Tzu dogs that presented to the veterinary medical teaching hospital of Chungnam National University between January 2016 and August 2018 were collected. The inclusion criteria were having a CT scan of appropriate quality to allow reconstruction into the 3D model and with a complete humerus and radius, being skeletally mature, weighing < 5 kg and not having orthopedic diseases including fractures, osteoarthritis or neoplasia.
The patients were positioned in sternal recumbency with cranial extension of both forelimbs, allowing the carpal, elbow and shoulder joints to lie in their neutral positions. CT scan images were produced by a 16-slice helical CT scanner using a 1 mm slice thickness with 50% overlap (Aquilion, Toshiba, Japan). Multiplanar reconstruction (MPR) was implemented, and each humerus and radius were adjusted in the frontal, sagittal and axial planes based on landmarks.
데이터처리
Means ± standard deviations (SDs) with 95% confidence intervals (95% CIs) were calculated for each of the joint reference angles (mMPHA, mLDHA, mCaPHA, mCrDHA, and HTA; aMPRA, aLDRA, aCrPRA, aCdDRA and RTA), and unpaired t-tests or Mann-Whitney U tests were used to compare the joint reference angles of the right versus left radii and humeri.
성능/효과
Additionally, the intraobserver reliability for the humerus was excellent for all the angles, and the interobserver reliability for the humerus was excellent in the frontal plane and moderate to good in the sagittal and axial planes. All the investigators completed training, and several refinements were required, even for experienced surgeons or surgical residents, to reach consistent results.
In conclusion, this report described the humeral and radial reference angle values for Shih Tzu dogs measured by reliable and repeatable CT methodology. Further studies with larger populations and clinical cases of thoracic limbs are needed to establish breed-specific joint reference angles and clinical offsets.
The inter- and intraobserver reliability of aLDRA in the frontal plane was good and excellent, respectively. In the sagittal plane of the radius, the interobserver reliability for the aCrPRA and the intraobserver reliability for the aCdDRA were excellent, and the intraobserver reliability for the aCrPRA and the interobserver reliability for the aCdDRA were good.
The reference values of the radial joint angles were obtained by methods used by other authors (9,14,16), and the measurement method of the humeral joint angle using CT was developed based on previous radiographic methodology (7). It was demonstrated that the computed tomographic evaluation of joint reference angles for both the radius and humerus was a repeatable and reliable method for determining standardized values. These results allowed us to confirm our hypothesis that previous methods for measuring other long bones are applicable to thoracic limbs, and it possible to establish valid values in one specific breed.
The CT measurement techniques used in this study demonstrated good to excellent reliability for the radius and moderate to excellent reliability for the humerus in normal Shih Tzu dogs. Surface landmarks for the thoracic limbs were easy to identify in all 3 planes, and all the investigators were able to attain consistent results for the measurements with three times of training.
The inclusion criteria were having a CT scan of appropriate quality to allow reconstruction into the 3D model and with a complete humerus and radius, being skeletally mature, weighing < 5 kg and not having orthopedic diseases including fractures, osteoarthritis or neoplasia.
후속연구
Excessive changes in the mLDHA with subsequent mechanical axis shifts could result in nonuniform joint loading. Further research is needed to suggest his relationship clinically because of the much smaller weights of Shih Tzu dogs than those of previously studied breeds. We defined the humeral joint reference angles of the mCaPHA and mCrDHA in the sagittal plane as 46.
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