Clavé A, Kerboull L, Musset T, Flecher X, Huten D, Lefèvre C, Gaucher F, Stindel E
Service de chirurgie orthopédique et traumatologique, faculté de médecine, université de Bretagne-Occidentale, hôpital de la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France.
Centre médico-chirurgical Paris V, 36, boulevard Saint-Marcel, 75005 Paris, France.
Orthop Traumatol Surg Res. 2014 Oct;100(6 Suppl):S323-6. doi: 10.1016/j.otsr.2014.07.007. Epub 2014 Sep 16.
Developmental dysplasia of the hip (DDH) leads to multiple treatment challenges during adulthood. Surgical treatment is mainly based on radiographic evaluation of the anatomical alterations. Several classification systems have been described in the published English scientific literature, but the French Cochin classification has not been used very much. Its primary advantage lies in its ability to intricately describe the DDH alterations with a large number of grades. We hypothesized that the inter- and intra-observer reproducibility of the SOFCOT-modified Cochin classification system was equal to that of the Crowe and Hartofilakidis classifications.
Five French orthopaedic surgeons who were DDH experts classified 94 A/P pelvis radiographs (179 hips) using the Crowe (Cr), Hartofilikadis (Ha) and modified Cochin (Co) systems. This evaluation was repeated a second time one month later. The intra-observer reproducibility was determined with weighted Kappa and concordance coefficients. The inter-observer reproducibility was performed by calculating the multirater Kappa coefficient on each of the two data series.
For the intra-observer reliability, the average weighed concordance coefficients (95% CI) were 88.62-94.52 for Cr, 89.43-93.80 for Ha and 92.14-95.71 for Co. The average weighed Kappa coefficients (95% CI) were 0.70-0.85 for Cr, 0.67-0.82 for Ha and 0.75-0.83 for Co. For the inter-observer reliability, the Kappa for each assessment round was 0.57 and 0.48 for Cr, 0.43 and 0.44 for Ha, and 0.43 and 0.37 for Co.
The intra- and inter-observer reliability for the modified Cochin classification system is the same as the one for the Crowe and Hartofilakidis classifications. The theoretical advantage of this classification system should be confirmed by comparing the findings with intra-operative anatomical observations.
LEVEL OF PROOF, TYPE OF STUDY: IV.
成人期发育性髋关节发育不良（DDH）带来了多种治疗挑战。手术治疗主要基于对解剖学改变的影像学评估。已发表的英文科学文献中描述了几种分类系统，但法国科钦分类法的使用并不广泛。其主要优点在于能够通过大量分级精细地描述DDH的改变。我们假设SOFCOT改良科钦分类系统在观察者间和观察者内的可重复性与克劳（Crowe）分类法和哈托菲利卡基斯（Hartofilakidis）分类法相同。
五位法国DDH专家骨科医生使用克劳（Cr）、哈托菲利卡基斯（Ha）和改良科钦（Co）系统对94张前后位骨盆X线片（179个髋关节）进行分类。一个月后重复进行该评估。观察者内可重复性通过加权Kappa系数和一致性系数来确定。观察者间可重复性通过计算两个数据系列中每一个的多评分者Kappa系数来进行。
对于观察者内可靠性，克劳分类法的平均加权一致性系数（95%置信区间）为88.62 - 94.52，哈托菲利卡基斯分类法为89.43 - 93.80，改良科钦分类法为92.14 - 95.71。克劳分类法的平均加权Kappa系数（95%置信区间）为0.70 - 0.85，哈托菲利卡基斯分类法为0.67 - 0.82，改良科钦分类法为0.75 - 0.83。对于观察者间可靠性，克劳分类法在每次评估轮次的Kappa系数分别为0.57和0.48，哈托菲利卡基斯分类法为0.43和0.44，改良科钦分类法为0.43和0.37。
改良科钦分类系统在观察者内和观察者间的可靠性与克劳分类法和哈托菲利卡基斯分类法相同。该分类系统的理论优势应通过将结果与术中解剖观察结果进行比较来证实。
证据水平、研究类型：IV级。
