通过影像学评估来确定剥脱性骨软骨炎“愈合”情况的可靠性。
The reliability to determine "healing" in osteochondritis dissecans from radiographic assessment.
作者信息
Parikh Shital N, Allen Marcus, Wall Eric J, May Megan M, Laor Tal, Zbojniewicz Andrew M, Eismann Emily A, Myer Gregory D
机构信息
Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
出版信息
J Pediatr Orthop. 2012 Sep;32(6):e35-9. doi: 10.1097/BPO.0b013e31825fa80f.
BACKGROUND
Current literature supporting treatment strategies for osteochondritis dissecans (OCD) has limited prognostic utility. Presently, there is no gold standard for an OCD "healing" outcome. Accurate and reliable determination of the OCD healed status on the basis of radiographs would be valuable to provide a guide for evidence-based treatment of OCD. The purpose of this study was to determine interrater and intrarater reliability of radiographic assessment of OCD lesion healing in the knee.
METHODS
A hospital database identified 39 consecutive patients with OCD in 42 knees, who were treated conservatively for at least 6 months. Patients were an average age of 11.9 years (±2.4 y). A total of 102 presentation slides were prepared, each containing 2 similar radiographic views from the same patient taken 6 months (±1 mo) apart. These slides were then categorized by 4 reviewers (1 orthopaedic surgeon, 1 orthopaedic fellow, and 2 musculoskeletal radiologists) blinded to patient data, as healed, not healed, or unable to evaluate the OCD lesion. Reviewers repeated their assessment at a minimum of 3 weeks after their first read. Intrarater and interrater reliability were measured with the Cohen κ coefficient and Randolph's free-marginal multirater κ, respectively, and with the percent agreement.
RESULTS
OCD lesion categorization demonstrated insufficient interrater reliability with a κ of 0.44 and 63% agreement. The notch view had the highest interrater reliability with a κ of 0.63% and 76% agreement, and the lateral view had the lowest interrater reliability with a κ of 0.29% and 53% agreement. The OCD lesion categorization demonstrated substantial intrarater reliability with a κ of 0.68% and 81% agreement.
CONCLUSIONS
Reviewers did not consistently agree on the "healing" status of the OCD lesions on the basis of radiographic assessments. Standard criteria to assess healing are needed to consistently evaluate OCD knee lesions in children.
LEVEL OF EVIDENCE
Not applicable.
背景
目前支持剥脱性骨软骨炎（OCD）治疗策略的文献对预后的参考价值有限。目前，尚无OCD“愈合”结果的金标准。基于X线片准确可靠地判定OCD愈合状态，对于为OCD的循证治疗提供指导具有重要价值。本研究的目的是确定膝关节OCD病变愈合的X线评估在不同评估者间及同一评估者内的可靠性。
方法
通过医院数据库确定了42个膝关节患有OCD的39例连续患者，这些患者接受了至少6个月的保守治疗。患者的平均年龄为11.9岁（±2.4岁）。共制备了102张呈现幻灯片，每张幻灯片包含同一患者相隔6个月（±1个月）拍摄的2张相似的X线片。然后由4名对患者数据不知情的评估者（1名骨科医生、1名骨科住院医师和2名肌肉骨骼放射科医生）将这些幻灯片分类为愈合、未愈合或无法评估OCD病变。评估者在首次阅读后至少3周重复其评估。分别采用Cohen κ系数和Randolph自由边缘多评估者κ系数以及一致率来测量同一评估者内和不同评估者间的可靠性。
结果
OCD病变分类显示不同评估者间可靠性不足，κ值为0.44，一致率为63%。髁间窝视图的不同评估者间可靠性最高，κ值为0.63%，一致率为76%，而侧位视图的不同评估者间可靠性最低，κ值为0.29%，一致率为53%。OCD病变分类显示同一评估者内可靠性较高，κ值为0.68%，一致率为81%。
结论
评估者对基于X线评估的OCD病变“愈合”状态未达成一致意见。需要标准的愈合评估标准来持续评估儿童OCD膝关节病变。
证据水平
不适用。
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