Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN.
J Pediatr Orthop. 2021 Mar 1;41(3):159-163. doi: 10.1097/BPO.0000000000001733.
An area of enlargement of the metaphyseal socket around the epiphyseal tubercle, termed the peritubercle lucency sign, has recently been introduced as a possible predictor of contralateral slipped capital femoral epiphysis in patients with previous unilateral slipped capital femoral epiphysis. This study aimed to assess intraobserver and interobserver reliability for detecting the presence or absence of the peritubercle lucency sign.
Thirty-five radiographs were presented to 6 fellowship-trained pediatric orthopaedic surgeons on 2 separate occasions 30 days apart, ensuring that the images were shown in a different order on the second exposure. Both times the reviewers recorded whether the peritubercle lucency sign was present or absent in each of the radiographs. Statistical analysis was performed to determine the intraobserver and interobserver reliability.
In the intraobserver analysis, percent agreement between the first and second time the radiographs were reviewed varied between 62.9% and 85.7%, for an average intraobserver agreement of 74.8%. κ values for the 6 reviewers varied between 0.34 and 0.716, with an average intraobserver κ value of 0.508. The interobserver percent agreement was 40.0% for the first time the radiographs were reviewed, 42.9% the second time, and the overall interobserver percent agreement was 29%. The interobserver κ value was 0.44 the first time the radiographs were reviewed, 0.45 the second time, and the overall interobserver κ value was 0.45.
On the basis of our findings, the peritubercle lucency has modest intraobserver and interobserver reliability at best and should be used with other currently used factors, such as age, presence of endocrinopathy, status of triradiate cartilage, posterior sloping angle, and modified Oxford score, in determining the need for prophylactic pinning. Further refinement of the definition of the peritubercle lucency sign may be needed to improve agreement and reliability of the sign.
Level III-prognostic study.
在骨骺结节周围干骺端出现的骨皮质透亮区，称为干骺端旁透亮区征，最近被认为是预测对侧股骨颈骨骺滑脱的一个可能指标，这种现象发生在既往有单侧股骨颈骨骺滑脱的患者中。本研究旨在评估观察者内和观察者间检测该透亮区征的存在或缺失的可靠性。
35 张 X 线片在 30 天的间隔内分两次呈现给 6 名接受过 fellowship培训的小儿矫形外科医生，确保第二次暴露时图像以不同的顺序显示。两次检查时，观察者均记录每张 X 线片中是否存在干骺端旁透亮区征。采用统计学分析方法来确定观察者内和观察者间的可靠性。
在观察者内分析中，第一次和第二次阅读 X 线片时的百分比一致性在 62.9%至 85.7%之间，平均观察者内一致性为 74.8%。6 名观察者的κ 值在 0.34 至 0.716 之间，平均观察者内κ 值为 0.508。第一次阅读 X 线片时的观察者间百分比一致性为 40.0%，第二次为 42.9%，总体观察者间百分比一致性为 29.0%。第一次阅读 X 线片时的观察者间κ 值为 0.44，第二次为 0.45，总体观察者间κ 值为 0.45。
根据我们的发现，干骺端旁透亮区的观察者内和观察者间可靠性充其量只是中等水平，在确定是否需要预防性钢针固定时，应结合其他目前使用的因素，如年龄、内分泌疾病的存在、三射状软骨的状态、后倾斜率和改良牛津评分。可能需要进一步细化干骺端旁透亮区征的定义，以提高该征象的一致性和可靠性。
III 级-预后研究。
