Marawar Satyajit V, Ordway Nathaniel R, Auston Darryl A, Kurra Swamy, Wang Dongliang, Simpson Venita M, Tallarico Richard A, Katz Danielle A, Palomino Kathryn, Palumbo Mark, Lavelle William F
Department of Orthopedics, Syracuse Veterans Affairs Medical Center, 800 Irving Ave., Syracuse, NY 13210, USA.
Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY 13210, USA.
Spine Deform. 2019 Jan;7(1):11-17. doi: 10.1016/j.jspd.2018.06.009.
After placing a thoracic three-vertebra segment saw bones model on a standardized turntable, a series of anteroposterior (AP) radiographs were obtained and then set in increments to 90° rotation. Then the specimen was instrumented with 35-mm pedicle screws bilaterally and the rotation process and image acquisition were repeated.
Assess reliability and accuracy of spine surgeons evaluating apical vertebral rotation (AVR) through surgeon's visual x-ray estimation, Nash-Moe system, Upasani trigonometric method, and Upasani grading system.
Accurate assessment of AVR is one measure surgeons can evaluate the success of intervention and potential loss of correction in scoliotic deformities.
Eighty-four representative images of uninstrumented and instrumented vertebral segments were blinded. AVR was estimated by five experienced spinal deformity surgeons using the four techniques. The surgeons' grading, estimates, and errors compared to actual rotation were calculated. Inter- and intraobserver reliability were calculated using interclass correlation (ICC).
Each surgeon's error for simple visual estimation for uninstrumented segments was 8.7° to 17.4° (average error = 12.4°), and for instrumented segments it was 7.7° to 11.3° (average error = 9.5°). Error for the Upasani trigonometric method was -6.7° to 11.6° (average error = 0.9°). There was relatively poor accuracy for Nash-Moe system (38.2%-53.9%) compared with the Upasani grading system (76.74%-80.23%). Interobserver reliability using the Nash-Moe method was good (0.844), with intraobserver reliability from fair to excellent (0.684-0.949). Interobserver reliability for the Upasani grading method was good (0.829), with intraobserver reliability from fair to good (0.751-0.869). We found excellent interobserver reliability for Upasani trigonometric classification (0.935) with fair to excellent intraobserver reliability (0.775-0.991). The interobserver reliability of surgeons' visual estimates was good (0.898) and the intraobserver reliability from good to excellent (0.866-0.99) without pedicle screws, and interobserver reliability was excellent (0.948) and intraobserver reliability also excellent (0.959-0.986) with pedicle screws.
We confirm that both techniques described by Upasani have good reliability and accuracy, appearing more accurate than surgeon's visual estimates or Nash-Moe system.
Level III.
将一个胸椎三节段锯骨模型放置在标准化转盘上，获取一系列前后位（AP）X线片，然后以90°旋转增量进行设置。接着在标本双侧置入35毫米椎弓根螺钉，并重复旋转过程和图像采集。
评估脊柱外科医生通过外科医生视觉X线估计、Nash-Moe系统、Upasani三角法和Upasani分级系统评估顶椎旋转（AVR）的可靠性和准确性。
准确评估AVR是外科医生评估脊柱侧弯畸形干预成功与否以及潜在矫正丢失情况的一项指标。
对84张未置入器械和已置入器械的椎体节段的代表性图像进行盲法处理。由五名经验丰富的脊柱畸形外科医生使用四种技术评估AVR。计算外科医生的分级、估计值以及与实际旋转相比的误差。使用组内相关系数（ICC）计算观察者间和观察者内的可靠性。
每位外科医生对未置入器械节段的简单视觉估计误差为8.7°至17.4°（平均误差 = 12.4°），对已置入器械节段的误差为7.7°至11.3°（平均误差 = 9.5°）。Upasani三角法的误差为-6.7°至11.6°（平均误差 = 0.9°）。与Upasani分级系统（76.74%-80.23%）相比，Nash-Moe系统的准确性相对较差（38.2%-53.9%）。使用Nash-Moe方法的观察者间可靠性良好（0.844），观察者内可靠性从中等到优秀（0.684-0.949）。Upasani分级方法的观察者间可靠性良好（0.829），观察者内可靠性从中等到良好（0.751-0.869）。我们发现Upasani三角分类的观察者间可靠性优秀（0.935），观察者内可靠性从中等到优秀（0.775-0.991）。在未使用椎弓根螺钉时，外科医生视觉估计的观察者间可靠性良好（0.898），观察者内可靠性从良好到优秀（0.866-0.99）；在使用椎弓根螺钉时，观察者间可靠性优秀（0.948），观察者内可靠性也优秀（0.959-0.986）。
我们证实Upasani描述的两种技术都具有良好的可靠性和准确性，似乎比外科医生的视觉估计或Nash-Moe系统更准确。
三级。
