Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY 10021, USA.
Knee Surg Sports Traumatol Arthrosc. 2011 Oct;19(10):1693-8. doi: 10.1007/s00167-011-1467-3. Epub 2011 Mar 23.
Lower extremity alignment is an important consideration prior to cartilage surgery and/or osteotomy about the knee. This is measured on full length standing hip to ankle radiographs, which has traditionally been done using hard copy radiographs. However, the advent of PACS (Picture Archiving and Communication Systems) has allowed these measurements to be done on computer based digital radiographs. The objectives of this study were to evaluate the intra- and inter-observer reliability of lower limb alignment measures manually obtained from hard copy radiographs versus using the Philips Easy Vision system, and to assess the subjective ease of use for the two methods.
Forty-two patients who underwent surgery and who had a standing hip to ankle radiograph on file were identified. Four raters, including two radiologists and two orthopaedic surgeons, measured each hard copy radiograph and computer image on two separate occasions. Three measurements were recorded for each hard copy radiograph and computer image-width of tibial plateau, the distance from the medial aspect of the tibial plateau to the weight-bearing line, and the mechanical axis.
All correlations for this study were high. For tibial plateau data, the hard copy radiographs compared to PACS demonstrated intra-class correlation coefficients (ICC) ranging from 0.93 to 0.99 for inter-rater reliability for the four raters. The ICC for intra-rater reliability for hard copies ranged from 0.90 to 0.99 and for PACS from 0.94 to 0.99. The inter-rater data comparing raters ranged from 0.87 to 0.98 for hard copy radiographs and from 0.98 to 0.99 for PACS. For mechanical axis data, the ICC for hard copy radiograph compared to PACS ranged from 0.93 to 0.97 for the intra-rater reliability for the four raters. The intra-rater reliability for mechanical axis data on hard copy radiograph ranged from an ICC of 0.86 to 0.96, and for PACS the ICC ranged from 0.93 to 0.99. The inter-observer data for hard copy radiographs using the mechanical axis ranged from 0.88 to 0.94 and for PACS ranged from 0.93 to 0.97. The physicians rated PACS as statistically significantly easier to use when compared to hard copy (P = 0.03).
Evaluation of lower extremity alignment using two techniques prior to knee surgery was found to have higher inter- and intra-observer reliability using PACS software. PACS is now used prior to cartilage surgery and/or osteotomy to measure both alignment and the location of the weight bearing line on the tibial plateau both before and after surgery.
Diagnostic study, Level I.
下肢对线是膝关节软骨手术和/或截骨术前的一个重要考虑因素。这是通过全长站立的髋关节到踝关节射线照相来测量的，传统上是通过硬拷贝射线照相来完成的。然而，PACS（影像归档和通信系统）的出现使得这些测量可以在基于计算机的数字射线照相上进行。本研究的目的是评估从硬拷贝射线照相手动获得的下肢对线测量值与使用飞利浦 Easy Vision 系统的测量值的内部和观察者间可靠性，并评估两种方法的主观易用性。
确定了 42 名接受手术且有站立髋关节到踝关节射线照相存档的患者。四名评分者，包括两名放射科医生和两名矫形外科医生，分别在两次测量了每张硬拷贝射线照相和计算机图像。为每张硬拷贝射线照相和计算机图像记录了三次测量值-胫骨平台的宽度、胫骨平台内侧到承重线的距离以及机械轴。
本研究的所有相关性均很高。对于胫骨平台数据，与 PACS 相比，硬拷贝射线照相的四位评分者的组内相关系数（ICC）范围为 0.93 至 0.99，用于评价观察者间可靠性。硬拷贝的组内可靠性的 ICC 范围为 0.90 至 0.99，而 PACS 的 ICC 范围为 0.94 至 0.99。比较评分者的观察者间数据，硬拷贝射线照相的 ICC 范围为 0.87 至 0.98，而 PACS 的 ICC 范围为 0.98 至 0.99。对于机械轴数据，与 PACS 相比，硬拷贝射线照相的 ICC 范围为 0.93 至 0.97，用于评价四位评分者的组内可靠性。硬拷贝射线照相机械轴数据的组内可靠性的 ICC 范围为 0.86 至 0.96，而 PACS 的 ICC 范围为 0.93 至 0.99。使用机械轴的硬拷贝射线照相的观察者间数据范围为 0.88 至 0.94，而 PACS 的范围为 0.93 至 0.97。与硬拷贝相比，医生认为 PACS 在使用时统计学上更容易（P=0.03）。
在膝关节手术前使用两种技术评估下肢对线，使用 PACS 软件发现观察者间和观察者内的可靠性更高。PACS 现在用于软骨手术和/或截骨术前，以在手术前后测量胫骨平台的对线和承重线的位置。
诊断研究，I 级。
