Ohrt-Nissen Søren, Cheung Jason Pui Yin, Hallager Dennis Winge, Gehrchen Martin, Kwan Kenny, Dahl Benny, Cheung Kenneth M C, Samartzis Dino
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen East, 2100 Denmark.
Department of Orthopedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor 102 Pokfulam Road, Hong Kong, SAR China.
Scoliosis Spinal Disord. 2017 Feb 21;12:4. doi: 10.1186/s13013-017-0112-4. eCollection 2017.
Current surgical treatment for adolescent idiopathic scoliosis (AIS) involves correction in both the coronal and sagittal plane, and thorough assessment of these parameters is essential for evaluation of surgical results. However, various definitions of thoracic kyphosis (TK) have been proposed, and the intra- and inter-rater reproducibility of these measures has not been determined. As such, the purpose of the current study was to determine the intra- and inter-rater reproducibility of several TK measurements used in the assessment of AIS.
Twenty patients (90% females) surgically treated for AIS with alternate-level pedicle screw fixation were included in the study. Three raters independently evaluated pre- and postoperative standing lateral plain radiographs. For each radiograph, several definitions of TK were measured as well as L1-S1 and nonfixed lumbar lordosis. All variables were measured twice 14 days apart, and a mixed effects model was used to determine the repeatability coefficient (RC), which is a measure of the agreement between repeated measurements. Also, the intra- and inter-rater intra-class correlation coefficient (ICC) was determined as a measure of reliability.
Preoperative median Cobb angle was 58° (range 41°-86°), and median surgical curve correction was 68% (range 49-87%). Overall intra-rater RC was highest for T2-T12 and nonfixed TK (11°) and lowest for T4-T12 and T5-T12 (8°). Inter-rater RC was highest for T1-T12, T1-nonfixed, and nonfixed TK (13°) and lowest for T5-T12 (9°). Agreement varied substantially between pre- and postoperative radiographs. Inter-rater ICC was highest for T4-T12 (0.92; 95% CI 0.88-0.95) and T5-T12 (0.92; 95% CI 0.88-0.95) and lowest for T1-nonfixed (0.80; 95% CI 0.72-0.88).
Considerable variation for all TK measurements was noted. Intra- and inter-rater reproducibility was best for T4-T12 and T5-T12. Future studies should consider adopting a relevant minimum difference as a limit for true change in TK.
目前青少年特发性脊柱侧凸（AIS）的手术治疗涉及冠状面和矢状面的矫正，全面评估这些参数对于评估手术效果至关重要。然而，已经提出了多种胸椎后凸（TK）的定义，这些测量方法在评分者内和评分者间的可重复性尚未确定。因此，本研究的目的是确定在评估AIS时使用的几种TK测量方法在评分者内和评分者间的可重复性。
本研究纳入了20例接受交替节段椎弓根螺钉固定手术治疗AIS的患者（90%为女性）。三名评分者独立评估术前和术后站立位侧位X线平片。对于每张X线平片，测量了几种TK的定义以及L1-S1和非固定腰椎前凸。所有变量在相隔14天的时间里测量两次，并使用混合效应模型确定重复性系数（RC），这是衡量重复测量之间一致性的指标。此外，还确定了评分者内和评分者间的组内相关系数（ICC）作为可靠性指标。
术前Cobb角中位数为58°（范围41°-86°），手术曲线矫正中位数为68%（范围49%-87%）。总体而言，评分者内RC在T2-T12和非固定TK方面最高（11°），在T4-T12和T5-T12方面最低（8°）。评分者间RC在T1-T12、T1-非固定和非固定TK方面最高（13°），在T5-T12方面最低（9°）。术前和术后X线平片之间的一致性差异很大。评分者间ICC在T4-T12（0.92；95%CI 0.88-0.95）和T5-T12（0.92；95%CI 0.88-0.95）方面最高，在T1-非固定方面最低（0.80；95%CI 0.72-0.8）。
所有TK测量均存在显著差异。评分者内和评分者间的可重复性在T4-T12和T5-T12方面最佳。未来的研究应考虑采用相关的最小差异作为TK真正变化的限度。
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