Department of Pediatric Orthopaedics, Orthopaedic Hospital Speising, Speisinger Strasse 109, A-1130 Vienna, Austria.
J Bone Joint Surg Am. 2010 Oct 20;92(14):2427-35. doi: 10.2106/JBJS.I.01444.
Radiographs have traditionally been used to describe and quantify foot deformities in infants and children. We hypothesized that the interobserver reliability of measurements obtained from radiographs of pediatric feet would be low, especially with regard to the infant foot, and that normal ranges and standard deviations would decrease in association with increasing patient age.
We retrospectively reviewed 494 radiographs of 121 patients treated for unilateral clubfoot at our institution and studied the contralateral normal foot. All anteroposterior radiographs, lateral radiographs, and lateral radiographs made with the foot in maximum dorsiflexion were analyzed by three observers, and the values were recorded. The databases created by the three observers were statistically analyzed according to five predefined age groups (birth to less than three months, three months to less than twelve months, twelve months to less than three years, three years to less than seven years, and seven years to less than fourteen years).
The anteroposterior talocalcaneal angle was rated as having good interobserver reliability (i.e., an intraclass correlation coefficient of 0.61 to 0.80) for all patients in each age group. Other angles that were associated with good interobserver reliability were the anteroposterior calcaneus-fifth metatarsal angle in the twelve months to less than three-year age group, the three-year to less than seven-year age group, and the seven-year to less than fourteen-year age group; the lateral talocalcaneal angle in the three-year to less than seven-year age group; the lateral tibiotalar angle in the three-year to less than seven-year age group; and the lateral talus-first metatarsal angle in the seven-year to less than fourteen-year age group. All other angles were rated as having very good interobserver reliability (i.e., an intraclass correlation coefficient of 0.81 to 1). The mean difference and the maximum difference among the observers decreased for all angles in nearly all age groups.
Interobserver reliability with regard to the radiographic measurement of pediatric feet was higher than expected, although measurement discrepancies can be as great as 30° with the infant foot. Interobserver reliability tended to improve with increasing patient age. The standard deviation showed a trend toward a decrease as patient age increased, although the trend was less notable than expected.
传统上，放射照片被用于描述和量化婴儿和儿童的足部畸形。我们假设，从儿科足部放射照片中获得的测量值的观察者间可靠性较低，尤其是对于婴儿足部，并且正常范围和标准偏差会随着患者年龄的增加而降低。
我们回顾性分析了我院 121 例单侧马蹄足患儿治疗的 494 例放射照片，研究了对侧正常足。所有前后位、侧位和足最大背屈位侧位放射照片均由 3 名观察者进行分析，并记录数值。根据 5 个预设年龄组（出生至不足 3 个月、3 个月至不足 12 个月、12 个月至不足 3 年、3 年至不足 7 年和 7 年至不足 14 年）对 3 名观察者创建的数据库进行统计学分析。
在每个年龄组的所有患者中，距骨跟骨前后角的观察者间可靠性均被评为具有良好的可靠性（即，组内相关系数为 0.61 至 0.80）。与良好的观察者间可靠性相关的其他角度包括 12 个月至 3 岁年龄组、3 岁至 7 岁年龄组和 7 岁至 14 岁年龄组的距骨第五跖骨前后角；3 岁至 7 岁年龄组的侧距骨跟骨角；3 岁至 7 岁年龄组的侧胫距关节角；7 岁至 14 岁年龄组的侧距骨第一跖骨角。所有其他角度的观察者间可靠性均被评为非常好（即，组内相关系数为 0.81 至 1）。在几乎所有年龄组中，所有角度的观察者间差异和最大差异均呈下降趋势。
尽管婴儿足部的测量差异可能高达 30°，但儿科足部放射照片的测量观察者间可靠性高于预期。观察者间可靠性随着患者年龄的增加而提高。虽然趋势并不像预期的那么明显，但随着患者年龄的增加，标准偏差呈下降趋势。
