3 种放射学分类方法评估 4 岁以上儿童发育性髋关节发育不良严重程度的可靠性。

Reliability of 3 Radiologic Classifications for the Severity of the Developmental Dysplasia of the Hip in Children Older Than 4 Years.

机构信息

Department of Pediatric Orthopaedics, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Karnataka.

Ganjwala Orthopaedics Hospital, Ahmedabad, Gujarat.

出版信息

J Pediatr Orthop. 2022 Jan 1;42(1):23-29. doi: 10.1097/BPO.0000000000002004.

DOI:10.1097/BPO.0000000000002004

PMID:34739436

Abstract

BACKGROUND

Tonnis, International Hip Dysplasia Institute (IHDI), and lateral metaphyseal height (LMH) are commonly used classifications for grading the severity of the developmental dysplasia of the hip. The reliability of these classifications is not widely studied in older children. The aim of the study was to evaluate the reliability of these 3 radiologic classifications in children older than 4 years and compared with children younger than 4 years and evaluate the cases with varied inter-rater reliability.

METHODS

A purposeful sample of 40 children with untreated developmental dysplasia of the hip with ages between 6 months to 8 years was studied for the assessment of the severity grading according to all 3 classifications. Six pediatric orthopaedic surgeons classified all hips for all 3 categorical classifications as per the original description. Inter-rater and intrarater reliability was calculated according to the intraclass correlation coefficient. The cases with different ratings were assessed in detail to evaluate the reasons for the varied rating.

RESULTS

The interobserver and intraobserver reliability of all 3 classifications were excellent [intraclass correlation coefficient (ICC): 0.935, 0.820, and 0.935 for IHDI, Tonnis, and LMH classification, respectively]. The excellent reliability was also observed in younger and older children. Interobserver reliability of only dysplastic hips (52 hips) was good for Tonnis (ICC: 0.741) and excellent for IHDI (ICC: 0.911) and LMH classification (ICC-0.9). The main reason for the varied rating was because of the varied perception of the superolateral margin of the acetabulum in few hips.

CONCLUSION

The inter-rater and intrarater reliability of all 3 classifications (IHDI, Tonnis, and LMH) is excellent. All classifications can be used till the age of 8 years. The difficulty in selecting the superolateral margin of the acetabulum is a major cause of inter-rater variability.

LEVEL OF STUDY

Level III.

摘要

背景

Tonnis 髋关节发育不良国际研究所 (IHDI) 和外侧骺干高度 (LMH) 是用于分级髋关节发育不良严重程度的常用分类方法。这些分类方法在年龄较大的儿童中的可靠性尚未得到广泛研究。本研究的目的是评估这些 3 种影像学分类在 4 岁以上儿童中的可靠性，并与 4 岁以下儿童进行比较，评估具有不同观察者间可靠性的病例。

方法

本研究采用目的抽样法选取了 40 例未经治疗的发育性髋关节发育不良的儿童，年龄在 6 个月至 8 岁之间，用于评估所有 3 种分类方法的严重程度分级。6 名小儿矫形外科医生根据原始描述对所有髋关节进行了所有 3 种分类的分类。根据组内相关系数计算了观察者间和观察者内可靠性。详细评估了具有不同评分的病例，以评估评分差异的原因。

结果

所有 3 种分类的观察者间和观察者内可靠性均为优秀[髋关节发育不良国际研究所（IHDI）、Tonnis 和 LMH 分类的组内相关系数（ICC）分别为 0.935、0.820 和 0.935]。在年龄较小和较大的儿童中也观察到了优秀的可靠性。Tonnis 分类（ICC：0.741）和 IHDI（ICC：0.911）和 LMH 分类（ICC：0.9）对发育不良髋关节（52 髋）的观察者间可靠性良好。评分差异的主要原因是少数髋关节髋臼外上缘的感知不同。