一举两得：低剂量脊柱立体放射成像时手部定位的改变可实现桑德斯骨骼成熟度分期的同时可靠评估。
Two for One: A Change in Hand Positioning During Low-Dose Spinal Stereoradiography Allows for Concurrent, Reliable Sanders Skeletal Maturity Staging.
作者信息
Jackson Taylor J, Miller Daniel, Nelson Susan, Cahill Patrick J, Flynn John M
机构信息
Division of Orthopaedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
Division of Orthopaedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
出版信息
Spine Deform. 2018 Jul-Aug;6(4):391-396. doi: 10.1016/j.jspd.2018.01.003.
STUDY DESIGN
Prospective survey.
OBJECTIVES
To evaluate the reliability of low-dose stereoradiography compared to standard hand bone age films for assessing Sanders skeletal maturity stage in patients with idiopathic scoliosis.
SUMMARY OF BACKGROUND DATA
The Sanders skeletal maturity staging system is a valuable tool in the care of juvenile and adolescent spine scoliosis, but obtaining dedicated hand films adds additional time, radiation, and expense to the clinic visit. A change in patient hand positioning for routine full-length PA spine low-dose stereoradiography may offer a viable alternative.
METHODS
A survey consisting of 30 standard bone age hand films and 26 posteroanterior spine low-dose stereoradiography images (magnified view of hands only) was created in REDCap and distributed to two pediatric spine surgeons and two fellows. The graders were asked to classify the images according to the Sanders skeletal maturity classifications. Images were graded in two trials conducted one week apart. Inter- and intraobserver reliability was assessed using the mean linearly weighted kappa to provide an overall index of agreement.
RESULTS
In Trial 1, the interobserver reliability was similar for both the standard bone age films (κ = 0.82) and for the low-dose stereoradiography films (κ = 0.79) (p = .501). In Trial 2, reliability was similar between imagine modalities and slightly improved for both standard bone age films (κ = 0.85) and low-dose stereoradiography films (κ = 0.82) (p = .192). Intraobserver reliability was strong for both standard films (κ=0.89) and low-dose stereoradiography films (κ = 0.86) (p = .446).
CONCLUSION
A simple change in patient hand positioning for low-dose stereoradiography allows clinicians to simultaneously assess a patient's spinal deformity and skeletal maturity with excellent reliability. Given the frequency of scoliosis surveillance visits, this simple change could lead to significant savings of time, money, and radiation exposure for the growing child.
LEVEL OF EVIDENCE
Level III.
研究设计
前瞻性调查。
目的
评估与标准手部骨龄片相比，低剂量立体放射摄影在评估特发性脊柱侧凸患者桑德斯骨骼成熟阶段的可靠性。
背景数据总结
桑德斯骨骼成熟分期系统是青少年脊柱侧凸治疗中的一个有价值的工具，但获取专门的手部X线片会增加就诊时间、辐射剂量和费用。在常规全长后前位脊柱低剂量立体放射摄影中改变患者手部位置可能是一种可行的替代方法。
方法
在REDCap中创建了一项调查，包括30张标准骨龄手部X线片和26张后前位脊柱低剂量立体放射摄影图像（仅手部放大视图），并分发给两名小儿脊柱外科医生和两名研究员。要求分级者根据桑德斯骨骼成熟分类对图像进行分类。在相隔一周进行的两次试验中对图像进行分级。使用平均线性加权kappa评估观察者间和观察者内的可靠性，以提供总体一致性指数。
结果
在试验1中，标准骨龄片（κ = 0.82）和低剂量立体放射摄影片（κ = 0.79）的观察者间可靠性相似（p = 0.501）。在试验2中，两种成像方式的可靠性相似，标准骨龄片（κ = 0.85）和低剂量立体放射摄影片（κ = 0.82）均略有提高（p = 0.192）。标准片（κ = 0.89）和低剂量立体放射摄影片（κ = 0.86）的观察者内可靠性都很强（p = 0.446）。
结论
在低剂量立体放射摄影中简单改变患者手部位置，可使临床医生同时评估患者的脊柱畸形和骨骼成熟度，且可靠性极佳。鉴于脊柱侧凸监测就诊的频率，这一简单改变可为成长中的儿童节省大量时间、金钱和辐射暴露。
证据级别
三级。
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