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用于髋关节发育不良手术决策的髋臼外侧缘和眉弓指数。

The lateral edge and sourcil acetabular indices for surgical decision-making in developmental dysplasia of the hip.

作者信息

Kothari Alpesh, Noor Saqib, Maddock Connor L, Vanderstappen Jan H H, Bradley Catharine S, Kelley Simon P

机构信息

The Hospital for Sick Children, Toronto, Canada.

Orthokliniek, Department of Orthopaedic Surgery, AZ Nikolaas, Sint-Niklaas, Belgium.

出版信息

J Child Orthop. 2020 Dec 1;14(6):513-520. doi: 10.1302/1863-2548.14.200199.

DOI:10.1302/1863-2548.14.200199
PMID:33343746
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7740684/
Abstract

PURPOSE

The acetabular index (AI) is a radiographic measure that guides surgical decision-making in developmental dysplasia of the hip (DDH). Two AI measurement methods are described; to the lateral edge of the acetabulum (AI-L) and to the lateral edge of the sourcil (AI-S). The purpose of this study was to determine the level of agreement between AI-L and AI-S on the diagnosis and degree of acetabular dysplasia in DDH.

METHODS

A total of 35 patients treated for DDH with Pavlik harness were identified. The AI-L and AI-S were measured on radiographs (70 hips) at two and five years of age. AI-L and AI-S were then transformed relative to published normative data (tAI-L and tAI-S). Bland-Altman plots, linear regression and heat mapping were used to evaluate the agreement between tAI-L and tAI-S.

RESULTS

There was poor agreement between tAI-S and tAI-L on the Bland-Altman plots with wide limits of agreement and no proportional bias. The two AI measurements were in agreement as to the presence and severity of dysplasia in only 63% of hips at two years of age and 81% at five years of age, leaving the remaining hips classified as various combinations of normal, mildly and severely dysplastic.

CONCLUSION

AI-L and AI-S have poor agreement on the presence or degree of acetabular dysplasia in DDH and cannot be used interchangeably. Clinicians are cautioned to prudently evaluate both measures of AI in surgical decision-making.

LEVEL OF EVIDENCE

I.

摘要

目的

髋臼指数（AI）是一种影像学测量指标，可指导发育性髋关节发育不良（DDH）的手术决策。文中描述了两种AI测量方法；一种是测量至髋臼外侧边缘（AI-L），另一种是测量至髋臼眉弓外侧边缘（AI-S）。本研究的目的是确定AI-L和AI-S在DDH髋臼发育不良的诊断及程度方面的一致性水平。

方法

共纳入35例接受 Pavlik 吊带治疗的 DDH 患者。在患者2岁和5岁时，对其髋关节X线片（共70个髋关节）测量AI-L和AI-S。然后将AI-L和AI-S相对于已发表的标准数据进行转换（tAI-L和tAI-S）。采用 Bland-Altman 图、线性回归和热图来评估tAI-L和tAI-S之间的一致性。

结果

在Bland-Altman图上，tAI-S和tAI-L之间的一致性较差，一致性界限较宽且无比例偏差。在2岁时，两种AI测量方法对于髋关节发育不良的存在及严重程度的判断仅在63%的髋关节中一致，5岁时为81%，其余髋关节被分类为正常、轻度和重度发育不良的各种组合。

结论

AI-L和AI-S在DDH髋臼发育不良的存在或程度方面一致性较差，不能互换使用。提醒临床医生在手术决策时谨慎评估两种AI测量方法。

证据水平

I级

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db22/7740684/2d347f107889/jco-14-513-g0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db22/7740684/e12c4b511770/jco-14-513-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db22/7740684/d104325de323/jco-14-513-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db22/7740684/3befe6058a91/jco-14-513-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db22/7740684/1681fd49d76d/jco-14-513-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db22/7740684/2d347f107889/jco-14-513-g0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db22/7740684/e12c4b511770/jco-14-513-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db22/7740684/d104325de323/jco-14-513-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db22/7740684/3befe6058a91/jco-14-513-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db22/7740684/1681fd49d76d/jco-14-513-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db22/7740684/2d347f107889/jco-14-513-g0005.jpg

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本文引用的文献

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2
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Int Orthop. 2018 Mar;42(3):631-640. doi: 10.1007/s00264-017-3726-5. Epub 2017 Dec 29.
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