Westberry David E, Davids Jon R, Roush Thomas F, Pugh Linda I
Shriners Hospitals For Children-Greenville, 950 W Faris Rd, Greenville, SC 29605, USA.
J Pediatr Orthop. 2008 Apr-May;28(3):359-65. doi: 10.1097/BPO.0b013e3181653b51.
Qualitative assessments of standing plain radiographs are frequently used to determine treatment strategies and assess outcomes for the management of a wide range of foot and ankle conditions in children. A quantitative technique for such analyses would presumably be more precise and reliable. The goal of this study was to compare qualitative and quantitative techniques for the assessment of plain radiographs of the foot and ankle in children with hemiplegic type cerebral palsy (CP).
Standing anteroposterior and lateral radiographs of the foot and ankle of the involved side for 49 children with hemiplegic CP were analyzed qualitatively by 2 pediatric orthopaedists, based upon a 3-segment (hindfoot, midfoot, and forefoot) foot model. Quantitative assessment of the same radiographs was performed by 2 examiners, using 6 radiographic measurements developed to describe the alignment of the foot based upon the same 3-segment model. Intraobserver and interobserver reliability was determined for both the qualitative and the quantitative techniques. The qualitative and quantitative techniques were compared to determine agreement.
The qualitative technique demonstrated poor-to-fair interobserver reliability (percent agreement range, 23%-31%; weighted kappa range, 0.291-0.568). The quantitative technique demonstrated good-to-excellent intraobserver (correlation coefficient range, 0.81-0.99) and interobserver (correlation coefficient range, 0.81-0.97) reliability. Percent agreement between the quantitative and the qualitative techniques for the assessment of foot segmental alignment for each examiner ranged from 22.2% to 100% (mean agreement for examiner 1 was 51% [correlation coefficient range, 0.04-0.48]; mean agreement for examiner 2 was 65.3% [correlation coefficient range, 0.22-0.85]). Percent agreement between the quantitative technique and both observers ranged from 11.1% to 83.3% (mean agreement was 36.7% [correlation coefficient range, 0.17-0.94]).
Reliable quantitative radiographic analysis of the segmental alignment of the involved foot and ankle in children with hemiplegic CP is possible and is more precise and reliable than traditional qualitative techniques. Quantitative techniques can identify a wider range of foot segmental malalignments and should facilitate deformity analysis, preoperative planning, assessment of outcome, and comparison of results between centers.
站立位普通X线片的定性评估常用于确定治疗策略并评估儿童多种足踝疾病的治疗效果。一种用于此类分析的定量技术可能会更加精确和可靠。本研究的目的是比较定性和定量技术在评估偏瘫型脑瘫（CP）患儿足踝部普通X线片方面的差异。
49例偏瘫型CP患儿患侧足踝部的站立位前后位和侧位X线片由2名儿科骨科医生基于三段式（后足、中足和前足）足部模型进行定性分析。2名检查者对相同的X线片进行定量评估，使用基于相同三段式模型开发的6项X线测量指标来描述足部的对线情况。确定定性和定量技术的观察者内及观察者间可靠性。比较定性和定量技术以确定一致性。
定性技术显示观察者间可靠性较差至中等（一致率范围为23%-31%；加权kappa范围为0.291-0.568）。定量技术显示观察者内（相关系数范围为0.81-0.99）和观察者间（相关系数范围为0.81-0.97）可靠性良好至优秀。每位检查者在评估足部节段对线的定量和定性技术之间的一致率范围为22.2%至100%（检查者1的平均一致率为51%[相关系数范围为0.04-0.48]；检查者2的平均一致率为65.3%[相关系数范围为0.22-0.85]）。定量技术与两位观察者之间的一致率范围为11.1%至83.3%（平均一致率为36.7%[相关系数范围为0.17-0.94]）。
对偏瘫型CP患儿患侧足踝部节段对线进行可靠的定量X线分析是可行的，并且比传统的定性技术更精确、更可靠。定量技术可以识别更广泛的足部节段排列不齐情况，应有助于畸形分析、术前规划、疗效评估以及不同中心之间结果的比较。
