Kunkle William Aaron, Madden Michael, Potts Shannon, Fogelson Jeremy, Hershman Stuart
Department of Orthopedic Surgery, Broward Health Medical Center, 1600 South Andrews Ave, Fort Lauderdale, FL 33316, USA.
Department of Orthopedic Surgery, Broward Health Medical Center, 1600 South Andrews Ave, Fort Lauderdale, FL 33316, USA.
Spine J. 2017 Oct;17(10):1559-1564. doi: 10.1016/j.spinee.2017.06.014. Epub 2017 Aug 14.
Smartphones have become an integral tool in the daily life of health-care professionals (Franko 2011). Their ease of use and wide availability often make smartphones the first tool surgeons use to perform measurements. This technique has been validated for certain orthopedic pathologies (Shaw 2012; Quek 2014; Milanese 2014; Milani 2014), but never to assess sagittal parameters in adult spinal deformity (ASD). This study was designed to assess the validity, reproducibility, precision, and efficiency of using a smartphone protractor application to measure sagittal parameters commonly measured in ASD assessment and surgical planning.
This study aimed to (1) determine the validity of smartphone protractor applications, (2) determine the intra- and interobserver reliability of smartphone protractor applications when used to measure sagittal parameters in ASD, (3) determine the efficiency of using a smartphone protractor application to measure sagittal parameters, and (4) elucidate whether a physician's level of experience impacts the reliability or validity of using a smartphone protractor application to measure sagittal parameters in ASD.
STUDY DESIGN/SETTING: An experimental validation study was carried out.
Thirty standard 36″ standing lateral radiographs were examined. Three separate measurements were performed using a marker and protractor; then at a separate time point, three separate measurements were performed using a smartphone protractor application for all 30 radiographs. The first 10 radiographs were then re-measured two more times, for a total of three measurements from both the smartphone protractor and marker and protractor. The parameters included lumbar lordosis, pelvic incidence, and pelvic tilt. Three raters performed all measurements-a junior level orthopedic resident, a senior level orthopedic resident, and a fellowship-trained spinal deformity surgeon. All data, including the time to perform the measurements, were recorded, and statistical analysis was performed to determine intra- and interobserver reliability, as well as accuracy, efficiency, and precision. Statistical analysis using the intra- and interclass correlation coefficient was calculated using R (version 3.3.2, 2016) to determine the degree of intra- and interobserver reliability.
High rates of intra- and interobserver reliability were observed between the junior resident, senior resident, and attending surgeon when using the smartphone protractor application as demonstrated by high inter- and intra-class correlation coefficients greater than 0.909 and 0.874 respectively. High rates of inter- and intraobserver reliability were also seen between the junior resident, senior resident, and attending surgeon when a marker and protractor were used as demonstrated by high inter- and intra-class correlation coefficients greater than 0.909 and 0.807 respectively. The lumbar lordosis, pelvic incidence, and pelvic tilt values were accurately measured by all three raters, with excellent inter- and intra-class correlation coefficient values. When the first 10 radiographs were re-measured at different time points, a high degree of precision was noted. Measurements performed using the smartphone application were consistently faster than using a marker and protractor-this difference reached statistical significance of p<.05.
Adult spinal deformity radiographic parameters can be measured accurately, precisely, reliably, and more efficiently using a smartphone protractor application than with a standard protractor and wax pencil. A high degree of intra- and interobserver reliability was seen between the residents and attending surgeon, indicating measurements made with a smartphone protractor are unaffected by an observer's level of experience. As a result, smartphone protractors may be used when planning ASD surgery.
智能手机已成为医疗保健专业人员日常生活中不可或缺的工具（弗兰科，2011年）。其易用性和广泛可用性常使智能手机成为外科医生进行测量的首选工具。该技术已在某些骨科疾病中得到验证（肖，2012年；奎克，2014年；米兰ese，2014年；米拉尼，2014年），但从未用于评估成人脊柱畸形（ASD）的矢状面参数。本研究旨在评估使用智能手机量角器应用程序测量ASD评估和手术规划中常用矢状面参数的有效性、可重复性、精度和效率。
本研究旨在（1）确定智能手机量角器应用程序的有效性，（2）确定使用智能手机量角器应用程序测量ASD矢状面参数时观察者内和观察者间的可靠性，（3）确定使用智能手机量角器应用程序测量矢状面参数的效率，以及（4）阐明医生的经验水平是否会影响使用智能手机量角器应用程序测量ASD矢状面参数的可靠性或有效性。
研究设计/设置：进行了一项实验性验证研究。
检查了30张标准的36英寸站立位侧位X线片。使用标记物和量角器进行三次单独测量；然后在另一个时间点，对所有30张X线片使用智能手机量角器应用程序进行三次单独测量。然后对前10张X线片再进行两次重新测量，智能手机量角器以及标记物和量角器总共进行三次测量。参数包括腰椎前凸、骨盆入射角和骨盆倾斜度。三名评估者进行了所有测量——一名初级骨科住院医师、一名高级骨科住院医师和一名接受过脊柱畸形 fellowship培训的外科医生。记录所有数据，包括测量时间，并进行统计分析以确定观察者内和观察者间的可靠性以及准确性、效率和精度。使用R（版本3.3.2，2016）计算组内和组间相关系数进行统计分析，以确定观察者内和观察者间的可靠程度。
使用智能手机量角器应用程序时，初级住院医师、高级住院医师和主治医生之间观察到观察者内和观察者间的高可靠性，组间和组内相关系数分别大于0.909和0.874。使用标记物和量角器时，初级住院医师、高级住院医师和主治医生之间也观察到观察者内和观察者间的高可靠性，组间和组内相关系数分别大于0.909和0.807。所有三名评估者均准确测量了腰椎前凸、骨盆入射角和骨盆倾斜度值，组间和组内相关系数值优异。当在不同时间点对前10张X线片进行重新测量时，观察到高度的精度。使用智能手机应用程序进行的测量始终比使用标记物和量角器更快——这种差异达到p<0.05的统计学显著性。
与标准量角器和蜡笔相比，可以使用智能手机量角器应用程序更准确、精确、可靠且更高效地测量成人脊柱畸形的X线参数。住院医师和主治医生之间观察到高度的观察者内和观察者间可靠性，表明使用智能手机量角器进行的测量不受观察者经验水平的影响。因此，在规划ASD手术时可使用智能手机量角器。
