CAJ | 학술논문

目的应用无标记的X线片评价手工测量特发性脊柱侧弯Cobb角的可信度和可重复性.方法 4名骨科医师独立对53例患儿的术前站立位全脊柱正位及侧位X线片进行2次冠状面及矢状面Cobb角测量,2次测量间隔2周.冠状面主弯和Cobb角大于10°的代偿弯以及与Lenke和/或PUMC分型相关的矢状面T2～5,T5～12、T10～L2、T12～L1角度纳入分析.应用组内相关系数判定可靠性和可重复性.结果 36例上胸弯、53例胸弯、41例胸腰弯/腰弯及矢状面T2～5、T5～12、T10～L2及T12～L1后弯Cobb角各53例纳入分析,主弯Cobb角22°～167°,平均54.4°.结果显示冠状面各角度测量中,上胸弯Cobb角的可信度(γ=0.592～0.714)和可重复性(γ=0.538～0.735)最差,有中等到好的一致性.胸弯Cobb角测量达到好到极佳的可信度(γ=0.881～0.942)和极佳的可重复性(γ=0.919～0.964).胸腰弯/腰弯角度测量有中等到极佳的可信度(γ=0.649～0.915)和好到极佳可重复性(γ=0.875～0.930).矢状面测量中,T2～5后弯Cobb角测量的可靠性最差,仅有低到中等的可信度(γ=0.373～0.662)和可重复性(γ=0.433～0.527).T5～12、T10～L2、T12～L1后弯cobb角测量均有好到极佳的可信度(分别为γ=0.787～0.909;0.857～0.964;0.889～0.983).T5～12Cobb 角测量有好到极佳的可重复性(γ=0.873～0.943),T10～L2、T12～L1 Cobb角测量均有极佳的可重复性(分别为γ=0.915～0.968;0.937～0.981).结论大多数的角度测量指标有好到极佳的可信度和可重复性,可以应用于临床工作和科研中.总体上冠状面角度测量一致性较矢状面好.由于受到周围组织阴影干扰,冠状面上胸弯和矢状面T2～5 Cobb角测量的一致性较差.
목적 응용무표기적X선편평개수공측량특발성척주측만Cobb각적가신도화가중복성.방법 4명골과의사독립대53례환인적술전참립위전척주정위급측위X선편진행2차관상면급시상면Cobb각측량,2차측량간격2주.관상면주만화Cobb각대우10°적대상만이급여Lenke화/혹PUMC분형상관적시상면T2～5,T5～12、T10～L2、T12～L1각도납입분석.응용조내상관계수판정가고성화가중복성.결과 36례상흉만、53례흉만、41례흉요만/요만급시상면T2～5、T5～12、T10～L2급T12～L1후만Cobb각각53례납입분석,주만Cobb각22°～167°,평균54.4°.결과 현시관상면각각도측량중,상흉만Cobb각적가신도(γ=0.592～0.714)화가중복성(γ=0.538～0.735)최차,유중등도호적일치성.흉만Cobb각측량체도호도겁가적가신도(γ=0.881～0.942)화겁가적가중복성(γ=0.919～0.964).흉요만/요만각도측량유중등도겁가적가신도(γ=0.649～0.915)화호도겁가가중복성(γ=0.875～0.930).시상면측량중,T2～5후만Cobb각측량적가고성최차,부유저도중등적가신도(γ=0.373～0.662)화가중복성(γ=0.433～0.527).T5～12、T10～L2、T12～L1후만cobb각측량균유호도겁가적가신도(분별위γ=0.787～0.909;0.857～0.964;0.889～0.983).T5～12Cobb 각측량유호도겁가적가중복성(γ=0.873～0.943),T10～L2、T12～L1 Cobb각측량균유겁가적가중복성(분별위γ=0.915～0.968;0.937～0.981).결론 대다수적각도측량지표유호도겁가적가신도화가중복성,가이응용우림상공작화과연중.총체상관상면각도측량일치성교시상면호.유우수도주위조직음영간우,관상면상흉만화시상면T2～5 Cobb각측량적일치성교차.
Objective To analyze the reliability of manual measurement of Cobb angle of the patients with idiopathic scoliosis.Methods Fifty three patients with idiopathic scoliosis had full-length standing posteroanterior and lateral radiographs were measured by four orthopedic surgeons independently.Coronal measures included Cobb angles of the three main curves.Sagittal parameters included T2-T5 and T5-T12 regional thoracic kyphosis,T10-L2 thoracolumbar junction sagittal curvature,T12-L2lumbar lordosis.The measurements were redone 2 weeks later.Inter-observer and intra-observer reliability for each parameter were assessed using intraclass correlation coefficient(ICC)method.Results Of the 53 patients,36 patients'proximal thoracic Cobb angles(PT),53 patients'main thoracic Cobb angles(MT),41 patients'thoracolumbar/lumbar Cobb angles,and all patients' T2-5.T5-12,T10-L2 and T12-L1 Cobb angles were measured.Main curves Cobb angles were 54.4(range,22 to 167).In the coronal Cobb angle measurements,the proximal thoracic curves measurements showed fair to good interobserver reliability(γ=0.592-0.714)and fair to good intraobserver reproducibility(γ=0.538-0.735);the main thoracic curves measurements showed good to excellent interobserver reliability(γ=0.881-0.942)and excellent intraobserver reproducibility(γ=0.919-0.964),while thoracolumbar/lumbar curves demonstrated fair to excellent interobserver reliability(γ=0.649-0.915)and good to excellent intraobserver reproducibility(γ=0.875-0.930).In the sagittal Cobb angle measurements,T2-5 curves demonstrated worst reliability and validity,low to fair interobserver reliability(γ=0.373-0.662)and intraobserver reproducibility(γ=0.433-0.527).T5-12,T10-L2 and T12-L1 curves demonstrated good to excellent interobserver reliability(γ=0.787-0.909;0.857-0.964;0.889-0.983).T5-12 curves demonstrated good to excellent intraobserver reproducibility(γ=0.873-0.943).T10-L2 and T12-L1 curves demonstrated excellent intraobserver reproducibility(γ=0.915-0.968;0.937-0.981).Conclusions The majority of the radiographic parameters for idiopathic scoliosis assessment demonstrate good or excellent reliability for manual measurement.