Kamath Surendra U, Austine Jose
Department of Orthopaedic Surgery, Kasturba Medical College, Mangalore, 575001, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
Foot (Edinb). 2018 Dec;37:91-94. doi: 10.1016/j.foot.2018.06.001. Epub 2018 Jun 8.
The lack in consensus with regard to qualitative use of standard radiographs and their predictive value in evaluating congenital talipes equinovarus among infants continues to be apparent in clinical practice. Since standard radiographs continue to play a role in the assessment of clubfoot it is essential to ensure that the values measured are reliable and reproducible keeping in mind acceptable tolerances for clinical application. This study was undertaken to assess the inter-observer and the intra-observer reliability in estimation of talocalcaneal and talo-first metatarsal angles on standard radiographs done according to Simon's method. The study was conducted by consecutively selecting eleven children with unilateral idiopathic congenital clubfoot who presented to our tertiary care hospital with a paediatric orthopaedic service unit. Only those with unilateral idiopathic clubfoot with persistent deformity at the age of 3 months were included. The data obtained from three observers on two separate occasions was analysed by the method proposed by Bland and Altman to assess intra and inter observer variability in the measurements. The results of the present study suggest a significant difference between the measurements on two occasions by the same observer. The difference was constant and the level of experience of the observer had no significance. Also, there was a marked inter observer variability as evident from the calculation of limit of agreement. Therefore, radiological assessment of the type and degree of malalignment in these cases is insufficient as it does not possess the accuracy required in evaluation and further management.
在临床实践中，对于婴儿先天性马蹄内翻足的标准X线片定性使用及其预测价值缺乏共识的情况仍然很明显。由于标准X线片在马蹄内翻足评估中仍发挥作用，因此必须确保所测量的值可靠且可重复，并牢记临床应用的可接受公差。本研究旨在评估根据西蒙方法拍摄的标准X线片上距跟角和距第一跖骨角测量的观察者间和观察者内可靠性。该研究通过连续选择11名单侧特发性先天性马蹄内翻足儿童进行，这些儿童到我们三级护理医院的小儿骨科服务单元就诊。仅纳入3个月大时单侧特发性马蹄内翻足且畸形持续存在的儿童。由三位观察者在两个不同时间获得的数据，采用布兰德和奥特曼提出的方法进行分析，以评估测量中观察者内和观察者间的变异性。本研究结果表明，同一观察者在两次测量之间存在显著差异。差异是恒定的，观察者的经验水平没有意义。此外，从一致性界限的计算可以明显看出，观察者间存在显著变异性。因此，这些病例中畸形排列类型和程度的放射学评估不足，因为它不具备评估和进一步治疗所需的准确性。
