Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital İzmir, Turkey.
Department of Orthopaedics and Traumatology, Akçakale State Hospital Şanlıurfa, Turkey.
Acta Orthop Traumatol Turc. 2020 Sep;54(5):530-534. doi: 10.5152/j.aott.2020.19075.
The aim of this study was to determine the role of hip arthrography in the treatment decision making for children with Legg-Calvé-Perthes disease (LCPD).
A total of 47 consecutive children with LCPD (42 boys, 5 girls; mean age=7.5 years; range=6-10 years) who underwent operative treatment were included in the study. The patient demographics, physical examination findings (pain and hip range of motion [ROM]), standard anteroposterior and Löwenstein lateral hip radiographs, and hip arthrography data were retrospectively collected. The arthrographies were performed immediately before the surgery under general anesthesia. The patients were staged according to the Catterall and Herring classifications and examined in terms of head-at-risk signs before the study. Four sets of patient files were established based on the aforementioned data, with each child in a randomized and blinded order. Ten consultant pediatric orthopedic surgeons randomly assessed the patient files on 4 separate occasions (Set 1 vs Set 2 and Set 3 vs Set 4), with a minimum time interval of 4 weeks. In the first and second sets, the demographic and clinical information, including the age, gender, hip ROM, and hip radiographs, were presented. In the third and fourth sets, hip arthrography was presented in addition to the data from Set 1 and Set 2. The observers were instructed to choose the best treatment options. The percent agreement (PA) and Gwet's AC1 statistics were used to establish a relative level of agreement among the observers.
The mean intra-observer reliabilities ranged from fair to moderate after adding the hip arthrography data (Gwet's AC1 = 0.36 for Set 1 vs Set 2 and 0.42 for Set 3 vs Set 4). The mean PA was 56.6% (range = 29.8% to 78.7%) with a Gwet's AC1 value of 0.51 (range: 0.21 to 0.77) between Set 1 and Set 3 (moderate intra-observer reliability). The decision for the treatment strategy was changed in 43.4% of the patients. For inter-observer reliability, Gwet's AC1 was computed as 0.48 (moderate reliability). The correlation between the intra-observer reliability and stage progression was not significant (p>0.05) for any of the subgroups. Thus, there is a negative correlation with the disease progression.
Hip arthrography seems to have a significant role in the treatment decision making for children with LCPD, especially in the advanced stages of the disease.
Level IV, Therapeutic study.
本研究旨在确定髋关节造影术在儿童 Legg-Calvé-Perthes 病（LCPD）治疗决策中的作用。
本研究纳入了 47 例接受手术治疗的 LCPD 患儿（42 名男孩，5 名女孩；平均年龄 7.5 岁；范围 6-10 岁）。回顾性收集患者的人口统计学资料、体格检查结果（疼痛和髋关节活动度[ROM]）、标准前后位和 Löwenstein 侧位髋关节 X 线片以及髋关节造影数据。在全身麻醉下，于手术前立即进行关节造影。根据 Catterall 和 Herring 分类对患者进行分期，并在研究前检查有风险的头征。根据上述数据建立了四组患者病历，每例患儿均以随机、盲法的顺序排列。10 名顾问小儿矫形外科医生在 4 次不同的时间（第 1 组与第 2 组和第 3 组与第 4 组）对患者病历进行随机评估，每次评估之间的最小时间间隔为 4 周。在第 1 组和第 2 组中，提供了人口统计学和临床信息，包括年龄、性别、髋关节 ROM 和髋关节 X 线片。在第 3 组和第 4 组中，除了第 1 组和第 2 组的数据外，还提供了髋关节造影数据。观察者被指示选择最佳治疗方案。使用百分一致率（PA）和 Gwet 的 AC1 统计数据来确定观察者之间的相对一致性水平。
在添加髋关节造影数据后，观察者的内部可靠性从一般到中度不等（Gwet 的 AC1 值为第 1 组与第 2 组的 0.36 和第 3 组与第 4 组的 0.42）。平均 PA 为 56.6%（范围为 29.8%至 78.7%），Gwet 的 AC1 值为 0.51（范围为 0.21 至 0.77），第 1 组与第 3 组之间具有中度内部观察者可靠性（moderate intra-observer reliability）。在 43.4%的患者中，治疗策略发生了变化。对于观察者之间的可靠性，Gwet 的 AC1 计算为 0.48（中度可靠性）。任何亚组的内部观察者可靠性与疾病进展之间均无显著相关性（p>0.05）。因此，与疾病进展呈负相关。
髋关节造影术似乎在儿童 LCPD 的治疗决策中具有重要作用，尤其是在疾病的晚期。
IV 级，治疗研究。
