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陶可主治醫(yī)師 北京大學(xué)人民醫(yī)院 骨關(guān)節(jié)科 使用數(shù)字X線照相、計(jì)算機(jī)輔助測(cè)量工具和Severin算法測(cè)量外側(cè)中心邊緣角和確定Severin分級(jí)系統(tǒng):重新審視觀察者內(nèi)和觀察者之間的可靠性:2011年JPediatrOrthop先天性髖臼發(fā)育不良,先天性髖關(guān)節(jié)半脫位,先髖,DDH作者:KristenLCarroll,KathleenAMurray,LynneMMacLeod,TheresaAHennessey,MarcellaRWoiczik,JamesWRoach.作者單位:SaltLakeCityShrineHospitalforChildren,FairfaxatVirginia,USA.譯者:陶可(北京大學(xué)人民醫(yī)院骨關(guān)節(jié)科)摘要背景:大量研究強(qiáng)調(diào)了外側(cè)中心邊緣角(CEA)和使用X線片測(cè)量的Severin分類的觀察者內(nèi)和觀察者間可靠性較差。在這項(xiàng)研究中,經(jīng)驗(yàn)豐富的觀察者應(yīng)用計(jì)算機(jī)輔助測(cè)量程序來(lái)確定先前接受過(guò)髖關(guān)節(jié)發(fā)育不良(DDH)治療的成人數(shù)字骨盆X線片中的CEA。使用Severin分類的教具/算法,觀察者隨后為這些髖關(guān)節(jié)分配了Severin等級(jí)。然后根據(jù)CEA測(cè)量和Severin分類計(jì)算觀察者內(nèi)和觀察者之間誤差。方法:4名兒科整形外科醫(yī)生和1名兒科放射科醫(yī)生使用OrthoViewTM計(jì)劃系統(tǒng)計(jì)算CEA,然后在41張盲法數(shù)字骨盆X線片上確定Severin分類。每位檢查員對(duì)X線片進(jìn)行兩次評(píng)估,評(píng)估相隔2個(gè)月。所有考官在進(jìn)行Severin分類系統(tǒng)之前都審查了Severin分類算法。CEA和Severin分類的觀察者內(nèi)和觀察者之間可靠性分別使用類間相關(guān)系數(shù)和Cohen和Fleissκ評(píng)分計(jì)算。結(jié)果:CEA測(cè)量的觀察者內(nèi)和觀察者之間信度中等至近乎完美。當(dāng)我們將Severin分類分為3個(gè)臨床相關(guān)組:良好(SeverinI和II)、發(fā)育不良(SeverinIII)和差(SeverinIV及以上)時(shí),我們的觀察者間可靠性幾乎接近完美。結(jié)論:Severin分類對(duì)于DDH治療的成功是非常有用且經(jīng)常使用的放射學(xué)測(cè)量方法。我們的研究發(fā)現(xiàn),數(shù)字X線照相術(shù)、計(jì)算機(jī)輔助測(cè)量工具、Severin算法的使用以及將Severin分類分為3個(gè)臨床相關(guān)組顯著提高了CEA和Severin分類的觀察者內(nèi)部和觀察者之間的可靠性。這一發(fā)現(xiàn)將有助于未來(lái)使用CEA和Severin分類對(duì)DDH治療結(jié)果進(jìn)行放射學(xué)評(píng)估的研究。?FIGURE1.ThecenteredgeangleismeasuredonapatientwithbilateralSeverinIIIhipsusingtheassistanceoftheMoseconcentriccirclesandanglemeasurementtoolscontainedintheOrthoViewTMsoftware.圖1.在OrthoViewTM軟件中包含的Mose同心圓和角度測(cè)量工具的幫助下,對(duì)雙側(cè)SeverinIII髖關(guān)節(jié)患者的外側(cè)中心邊緣角CEA進(jìn)行測(cè)量。TABLE1.SeverinAlgorithm表1.Severin算法TABLE2.InterobserverandIntraobserverReliabilityMeasuresforCEAsandSeverinRatings表2.外側(cè)中心邊緣角CEA和Severin評(píng)級(jí)的觀察者之間和觀察者內(nèi)可靠性檢測(cè)TABLE3.IntraobserverReliabilityforCenterEdgeAngles表3.外側(cè)中心邊緣角CEA的觀察者內(nèi)可靠性TABLE4.InterobserverReliabilityforCenterEdgeAngles表4.外側(cè)中心邊緣角CEA的觀察者之間可靠性TABLE5.IntraobserverReliabilityforSeverinandClinicallyRelevantGroups表5.Severin和臨床相關(guān)分組的觀察者內(nèi)可靠性TABLE6.InterobserverReliabilityforSeverinGrades表6.Severin等級(jí)的觀察者之間可靠性MeasurementofthecenteredgeangleanddeterminationoftheSeverinclassificationusingdigitalradiography,computer-assistedmeasurementtools,andaSeverinalgorithm:intraobserverandinterobserverreliabilityrevisitedAbstractBackground:Numerousstudiesunderscorethepoorintraobserverandinterobserverreliabilityofboththecenteredgeangle(CEA)andtheSeverinclassificationusingplainfilmmeasurements.Inthisstudy,experiencedobserversappliedacomputer-assistedmeasurementprogramtodeterminetheCEAindigitalpelvicradiographsofadultswhohadbeenpreviouslytreatedfordysplasiaofthehip(DDH).Usingateachingaid/algorithmoftheSeverinclassification,theobserversthenassignedaSeverinratingtothesehips.IntraobserverandinterobservererrorswerethencalculatedonboththeCEAmeasurementsandtheSeverinclassifications.Methods:Fourpediatricorthopaedicsurgeonsand1pediatricradiologistcalculatedtheCEAsusingtheOrthoViewTMplanningsystemandthendeterminedtheSeverinclassificationon41blindeddigitalpelvicradiographs.Theradiographswereevaluatedbyeachexaminertwice,withevaluationsseparatedby2months.AllexaminersreviewedaSeverinclassificationalgorithmbeforemakingtheirSeverinassignments.TheintraobserverandinterobserverreliabilityforboththeCEAandtheSeverinclassificationwerecalculatedusingtheinterclasscorrelationcoefficientsandCohenandFleissκscores,respectively.Results:TheintraobserverandinterobserverreliabilityforCEAmeasurementwasmoderatetoalmostperfect.WhenweseparatedtheSeverinclassificationinto3clinicallyrelevantgroupsofgood(SeverinIandII),dysplastic(SeverinIII),andpoor(SeverinIVandabove),ourinterobserverreliabilitynearedalmostperfect.Conclusion:TheSeverinclassificationisanextremelyusefulandoft-usedradiographicmeasureforthesuccessofDDHtreatment.Ourresearchfounddigitalradiography,computer-aidedmeasurementtools,theuseofaSeverinalgorithm,andseparatingtheSeverinclassificationinto3clinicallyrelevantgroupssignificantlyincreasedtheintraobserverandinterobserverreliabilityofboththeCEAandSeverinclassification.ThisfindingwillassistfuturestudiesusingtheCEAandSeverinclassificationintheradiographicassessmentofDDHtreatmentoutcomes.文獻(xiàn)出處:KristenLCarroll,KathleenAMurray,LynneMMacLeod,TheresaAHennessey,MarcellaRWoiczik,JamesWRoach.MeasurementofthecenteredgeangleanddeterminationoftheSeverinclassificationusingdigitalradiography,computer-assistedmeasurementtools,andaSeverinalgorithm:intraobserverandinterobserverreliabilityrevisited.JPediatrOrthop.2011Jun;31(4):e30-5.doi?10.1097/BPO.0b013e31821adde9.2022年02月20日
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