Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, 701 North First Street, Room D220, Springfield, IL 62702, USA.
J Bone Joint Surg Am. 2012 Jun 20;94(12):e86. doi: 10.2106/JBJS.K.00311.
Radiographic measures such as the rib vertebral angle difference (RVAD), Cobb angle, and space available for the lung (SAL) help to guide treatment and measure treatment effects in patients with infantile idiopathic scoliosis. This study aimed to evaluate the intraobserver and interobserver reliability of these radiographic measures.
Forty-five spine radiographs of skeletally immature patients (age, two months to four years) with infantile idiopathic scoliosis were measured with use of Surgimap software. Three pediatric orthopaedic surgeons and a pediatric orthopaedic fellow identified the major curve apex, rib-vertebra phase, Cobb angle, and end vertebrae and calculated the RVAD and SAL values at two separate time points. Interobserver and intraobserver reliability of the RVAD, Cobb angle, and SAL values were assessed with use of intraclass correlation coefficients (ICCs). Fleiss kappa coefficients were calculated for categorical variables.
The RVAD (ICC = 0.86 to 0.92) and Cobb angle (ICC = 0.99) measurements had high reliability. The SAL value had substantial interobserver reliability (ICC = 0.66) and moderate intraobserver reliability (ICC = 0.73). Despite the high agreement for the Cobb angle, the choice of the major curve vertebrae (kappa = 0.19 to 0.39) and apical vertebra varied (kappa = 0.57 to 0.62). Observers were more likely to choose the same apical vertebra in large curves (r = 0.483, p = 0.001). The agreement for the apical rib-vertebra phase was substantial (kappa = 0.67). Paired RVAD measurements fell within ≤ 10° of each other in 82% of cases, but the remaining 18% of the RVAD measurements showed >10° of variation.
Measurements used to guide treatment of infantile idiopathic scoliosis curves were reliable despite standard radiographic measurement error and the difficulty in obtaining quality images in young patients. Clinicians are dependent on seemingly objective radiographic data. The reliability of the Cobb angle and RVAD measurements in infantile scoliosis was high but not devoid of variability that could skew the ability to accurately and reliably suggest the best course of treatment. The SAL value was a less reliable measure. Treatment recommendations for infantile idiopathic scoliosis should rely on the synthesis of objective and clinically subjective data, as variations in radiographic measurements can lead to inconsistencies in management and to inconsistent treatment outcomes.
肋骨椎骨角度差（RVAD）、Cobb 角和肺可用空间（SAL）等影像学测量有助于指导治疗并衡量婴儿特发性脊柱侧凸患者的治疗效果。本研究旨在评估这些影像学测量的观察者内和观察者间可靠性。
使用 Surgimap 软件对 45 例骨骼未成熟的婴儿特发性脊柱侧凸患者（年龄 2 个月至 4 岁）的脊柱 X 光片进行测量。三位小儿矫形外科医生和一位小儿矫形外科住院医师确定主曲线顶点、肋骨椎骨阶段、Cobb 角和末端椎骨，并在两个不同时间点计算 RVAD 和 SAL 值。使用组内相关系数（ICC）评估 RVAD、Cobb 角和 SAL 值的观察者内和观察者间可靠性。对于分类变量，计算 Fleiss kappa 系数。
RVAD（ICC=0.86 至 0.92）和 Cobb 角（ICC=0.99）测量具有很高的可靠性。SAL 值具有较高的观察者间可靠性（ICC=0.66）和中等观察者内可靠性（ICC=0.73）。尽管 Cobb 角的一致性很高，但主曲线椎骨（kappa=0.19 至 0.39）和顶点椎骨的选择存在差异（kappa=0.57 至 0.62）。观察者更有可能在大曲线中选择相同的顶点椎骨（r=0.483，p=0.001）。顶点肋骨椎骨阶段的一致性很高（kappa=0.67）。在 82%的情况下，配对 RVAD 测量值彼此相差≤10°，但其余 18%的 RVAD 测量值显示出>10°的变化。
尽管存在标准影像学测量误差和年轻患者获得高质量图像的困难，但用于指导婴儿特发性脊柱侧凸曲线治疗的测量值是可靠的。临床医生依赖于看似客观的影像学数据。婴儿脊柱侧凸的 Cobb 角和 RVAD 测量值的可靠性很高，但并非没有可能导致治疗建议出现偏差的可变性。SAL 值是一种可靠性较低的测量值。婴儿特发性脊柱侧凸的治疗建议应依赖于客观和临床主观数据的综合，因为影像学测量值的变化可能导致管理不一致和治疗结果不一致。
