桑德斯分类法与里塞尔分期法的观察者间及观察者内可靠性
The Interobserver and Intraobserver Reliability of the Sanders Classification Versus the Risser Stage.
作者信息
Vira Shaleen, Husain Qasim, Jalai Cyrus, Paul Justin, Poorman Gregory W, Poorman Caroline, Yoon Richard S, Looze Christopher, Lonner Baron, Passias Peter G
机构信息
*Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center †Department of Orthopaedic Surgery, Mount Sinai Medical Center Beth Israel Hospital, New York, NY.
出版信息
J Pediatr Orthop. 2017 Jun;37(4):e246-e249. doi: 10.1097/BPO.0000000000000891.
BACKGROUND
Estimation of skeletal maturity, classically performed using Risser sign, plays a crucial role in the treatment of AIS. Recent data, however, has shown the simplified Tanner-Whitehouse (Sanders) classification, based on an anteriorposterior (AP) hand radiographs, to correlate more closely to the rapid growth phase and thus curve progression. This study evaluated the interobserver and intraobserver reliability of the Sanders and Risser classifications among clinicians at different levels of training.
METHODS
Twenty AP scoliosis radiographs and 20 AP hand radiographs were randomized and distributed to 11 graders. The graders consisted of 3 orthopaedic residents, 3 spine fellows, 3 spine surgeons, and 1 radiologist. The graders were then asked to classify the radiographs according to the Sanders and Risser classifications. There were 3 rounds of grading, each done 3 weeks apart. The overall κ coefficient was then calculated for each system to evaluate the interobserver and intraobserver reliability.
RESULTS
For all graders the average κ coefficient for the interobserver and intraobserver reliability of the Sanders classification was 0.54 and 0.62, respectively, and 0.46 and 0.49 for the Risser classification. With respect to spine attendings alone, the average κ coefficient for the interobserver and intraobserver reliability of Sanders classification was 0.72 and 0.77, respectively, and 0.46 and 0.67 for the Risser classification.
CONCLUSIONS
Our study demonstrated that the Sanders classification had moderate reliability with respect to physicians at various levels of training and had good reliability with respect to attending spine surgeons. Interestingly, the Risser staging was found to have less interobserver and intraobserver reliability overall. The Sanders classification is a reliable and reproducible system and should be in the armamentarium of surgeons who treat adolescent idiopathic scoliosis.
LEVEL OF EVIDENCE
Level III.
背景
骨骼成熟度的评估传统上采用里塞尔征，在特发性脊柱侧凸（AIS）的治疗中起着关键作用。然而，最近的数据表明，基于前后位（AP）手部X光片的简化坦纳 - 怀特豪斯（桑德斯）分类与快速生长阶段及曲线进展的相关性更强。本研究评估了不同培训水平的临床医生对桑德斯和里塞尔分类的观察者间及观察者内可靠性。
方法
将20张AP脊柱侧凸X光片和20张AP手部X光片随机分配给11名评分者。评分者包括3名骨科住院医师、3名脊柱专科住院医生、3名脊柱外科医生和1名放射科医生。然后要求评分者根据桑德斯和里塞尔分类对X光片进行分类。共有3轮评分，每轮间隔3周进行。随后计算每个系统的总体κ系数，以评估观察者间及观察者内可靠性。
结果
对于所有评分者，桑德斯分类的观察者间和观察者内可靠性的平均κ系数分别为0.54和0.62，里塞尔分类的平均κ系数分别为0.46和0.49。仅就脊柱主治医生而言，桑德斯分类的观察者间和观察者内可靠性的平均κ系数分别为0.72和0.77，里塞尔分类的平均κ系数分别为0.46和0.67。
结论
我们的研究表明，桑德斯分类对于不同培训水平的医生具有中等可靠性，对于脊柱主治医生具有良好可靠性。有趣的是，总体上里塞尔分期的观察者间和观察者内可靠性较低。桑德斯分类是一个可靠且可重复的系统，应纳入治疗青少年特发性脊柱侧凸的外科医生的工具库中。
证据水平
三级。
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