Gabriel Daniel B, Southard Karin A, Qian Fang, Marshall Steven D, Franciscus Robert G, Southard Thomas E
United States Air Force, Okinawa, Japan.
Am J Orthod Dentofacial Orthop. 2009 Oct;136(4):478.e1-7; discussion 478-80. doi: 10.1016/j.ajodo.2007.08.028.
The cervical vertebrae maturation (CVM) method has been advocated as a predictor of peak mandibular growth. This method relies on the clinician's ability to determine the stage of maturation of the vertebrae. Careful examination of reports of this technique shows methodologic flaws that can lead to inflated levels of reproducibility. The purpose of this study was to evaluate the reproducibility of CVM stage determination by using a more stringent methodology.
Ten practicing orthodontists, trained in the CVM method, evaluated 30 individual and 30 pairs of cephalometric radiographs in 2 sessions to determine the CVM stage. Interobserver and intraobserver reliability was determined by using the Kendall coefficient of concordance and the weighted kappa statistic.
All degrees of interobserver and intraobserver agreement were moderate (Kendall's W, 0.4-0.8). Interobserver agreement levels for CVM staging of the 10 orthodontists at both times were below 50%. Agreement improved marginally with the use of 2 longitudinal radiographs. Intraobserver agreement was only slightly better; on average, clinicians agreed with their own staging only 62% of the time.
Based on these results, we cannot recommend the CVM method as a strict clinical guideline for the timing of orthodontic treatment.
颈椎成熟度（CVM）方法已被提倡作为下颌骨生长高峰的预测指标。该方法依赖于临床医生确定椎体成熟阶段的能力。仔细审查该技术的报告可发现方法学上的缺陷，这些缺陷可能导致重复性水平虚高。本研究的目的是使用更严格的方法评估CVM阶段确定的可重复性。
10名接受过CVM方法培训的正畸医生在两个阶段评估了30张个体头颅侧位片和30对头颅侧位片，以确定CVM阶段。通过使用肯德尔和谐系数和加权kappa统计量来确定观察者间和观察者内的可靠性。
观察者间和观察者内的一致性程度均为中等（肯德尔W系数，0.4 - 0.8）。10名正畸医生在两个时间点对CVM分期的观察者间一致性水平均低于50%。使用两张纵向X线片时，一致性略有提高。观察者内一致性仅略好一些；平均而言，临床医生仅在62%的时间内与自己的分期一致。
基于这些结果，我们不能推荐将CVM方法作为正畸治疗时机的严格临床指南。
