Liu D, Xia S Q, Shi B, Shi B L, Liu Z, Sun X, Qiu Y, Zhu Z Z
Department of Spinal Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China.
Zhonghua Yi Xue Za Zhi. 2018 Nov 20;98(43):3479-3484. doi: 10.3760/cma.j.issn.0376-2491.2018.43.004.
To compare the reliability and repeatability of simplified skeletal maturity scoring (SSMS) and thumb ossification composite index (TOCI) in the assessment of skeletal maturity in adolescent idiopathic scoliosis(AIS) and their clinical utilization. A review was conducted on 500 AIS patients treated between October 2006 and August 2013 in Nanjing Drum Tower Hospital and one follow-up of each patient was randomly selected for this study.Based on SSMS and TOCI, the radiographs of the left palm were assessed by three observers independently with an interval of 2 weeks.The inter-observer reliability and intra-observer repeatability of two methods were analyzed by using Kappa value. A total of 3 000 measurements were performed by the 3 surgeons for each method.For SSMS, 50 cases were described as stage 1 258 cases as stage 2 962 cases as stage 3 340 cases as stage 4 315 cases as stage 5 304 cases as stage 6 589 cases as stage 7 and 182 cases as stage 8.The inter-observer and intra-observer agreements was 76.8%-82.0% ( value 0.716-0.778) and 75.8%-82.4% ( value 0.705-0.782), respectively.For TOCI, 27 cases were described as stage 1 183 cases as stage 2 167 cases as stage 3 171 cases as stage 4 745 cases as stage 5 536 cases as stage 6 410 cases as stage 7 and 761 cases as stage 8.The inter-observer and intra-observer agreements was 91.6%-92.4% ( value 0.897-0.907) and 90.4%-92.0%( value 0.882-0.902), respectively. The two methods of SSMS and TOCI have substantial inter-observer reliability and intra-observer reproducibility for the assessment of skeletal maturity in AIS.TOCI has relatively higher reliability and repeatability when compared with SSMS.
比较简化骨骼成熟度评分（SSMS）和拇指骨化综合指数（TOCI）在评估青少年特发性脊柱侧凸（AIS）骨骼成熟度方面的可靠性和可重复性及其临床应用。对2006年10月至2013年8月在南京鼓楼医院接受治疗的500例AIS患者进行回顾性研究，并随机选择每位患者的一次随访进行本研究。基于SSMS和TOCI，由三名观察者独立对左手掌X线片进行评估，间隔2周。采用Kappa值分析两种方法的观察者间可靠性和观察者内重复性。每种方法由3名外科医生共进行3000次测量。对于SSMS，50例为1期，258例为2期，962例为3期，340例为4期，315例为5期，304例为6期，589例为7期，182例为8期。观察者间和观察者内一致性分别为76.8%-82.0%（Kappa值0.716-0.778）和75.8%-82.4%（Kappa值0.705-0.782）。对于TOCI，27例为1期，183例为2期，167例为3期，171例为4期，745例为5期，536例为6期，410例为7期，761例为8期。观察者间和观察者内一致性分别为91.6%-92.4%（Kappa值0.897-0.907）和90.4%-92.0%（Kappa值0.882-0.902）。SSMS和TOCI这两种方法在评估AIS骨骼成熟度方面具有较高的观察者间可靠性和观察者内可重复性。与SSMS相比，TOCI具有相对更高的可靠性和可重复性。
