基于 CT 的原发性肘关节炎放射学分类的观察者内和观察者间可靠性：与基于平片的分类和临床评估的比较。
Intraobserver and interobserver reliability of the computed tomography-based radiographic classification of primary elbow osteoarthritis: comparison with plain radiograph-based classification and clinical assessment.
机构信息
Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea.
Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.
出版信息
Osteoarthritis Cartilage. 2019 Jul;27(7):1057-1063. doi: 10.1016/j.joca.2019.03.004. Epub 2019 Mar 25.
OBJECTIVES
To develop a staging system that could better reflect symptoms by the spurs quantification in the fossa and joint space narrowing using computed tomography (CT) for elbow arthritis and to evaluate its reproducibility with multiple readers.
METHODS
This retrospective study evaluated 81 cases of primary elbow osteoarthritis using both plain radiography and CT. Qualitative and quantitative analyses were independently performed by four orthopedic surgeons using previous and newly proposed staging systems. The reproducibility of the new system was analyzed with intraclass correlation coefficients (ICC). Correlations between symptoms and radiologic classification were assessed using Pearson's correlation coefficient (PCC).
RESULTS
The interobserver agreement (1) and intraobserver agreement (2) among the four evaluators was present by ICC. (1) The system of Hastings and Rettig [first observation, 0.544 (95% confidence interval (CI), 0.436-0.649); second observation, 0.582 (95% CI, 0.478-0.682)] and Broberg and Morrey's staging system [first observation, 0.620 (95% CI, 0.521-0.714); second observation, 0.656 (95% CI, 0.562-0.743)] showed substantial and moderate retrospective agreement, whereas the CT-based staging system showed almost perfect agreement [first observation, 0.867 (95% CI, 0.820-0.906); second observation, 0.909 (95% CI, 0.875-0.936)]. (2) The intraobserver agreement was almost perfect in the Brogerg and Morrey's and CT-based staging systems. CT-based staging showed high correlation with visual analogue scale (PCC 0.754, P < 0.001) and Mayo elbow performance score (PCC -0.614, P < 0.001) and moderate correlation with range of motion (PCC -0.458, P < 0.001).
CONCLUSIONS
CT-based staging system was highly reproducible and clinically feasible than previous plain radiograph-based staging systems.
目的
开发一种分期系统，该系统可通过使用计算机断层扫描（CT）对肘关节炎的髁突定量和关节间隙变窄来更好地反映症状，并通过多位读者评估其可重复性。
方法
本回顾性研究使用普通放射摄影术和 CT 评估了 81 例原发性肘关节炎。4 名矫形外科医生使用以前和新提出的分期系统进行了定性和定量分析。使用组内相关系数（ICC）分析新系统的可重复性。使用 Pearson 相关系数（PCC）评估症状与放射学分类之间的相关性。
结果
四位评估者的观察者间一致性（1）和观察者内一致性（2）均通过 ICC 呈现。（1） Hastings 和 Rettig 系统[首次观察，0.544（95％置信区间（CI），0.436-0.649）；第二次观察，0.582（95％CI，0.478-0.682）]和 Broberg 和 Morrey 分期系统[首次观察，0.620（95％CI，0.521-0.714）；第二次观察，0.656（95％CI，0.562-0.743）]显示出实质性和中度回顾性一致性，而基于 CT 的分期系统则显示出几乎完美的一致性[首次观察，0.867（95％CI，0.820-0.906）；第二次观察，0.909（95％CI，0.875-0.936）]。（2）Broberg 和 Morrey 及基于 CT 的分期系统中观察者内的一致性几乎是完美的。基于 CT 的分期与视觉模拟量表（PCC 0.754，P<0.001）和 Mayo 肘功能评分（PCC-0.614，P<0.001）高度相关，与运动范围（PCC-0.458，P<0.001）中度相关。
结论
与以前基于普通射线照相的分期系统相比，基于 CT 的分期系统具有高度的可重复性和临床可行性。
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