Department of Orthopedic Surgery, Johns Hopkins University, JHOC, 1800 Orleans Street, Baltimore, MD, 21287, USA.
Spine Deform. 2022 Sep;10(5):1071-1076. doi: 10.1007/s43390-022-00520-w. Epub 2022 May 18.
Skeletal maturity assessment may be performed using low-dose scoliosis radiographs (LDSS) with simultaneous imaging of the hand or proximal humerus. We sought to compare the practicality, reliability and validity of the Sanders skeletal maturity staging (SMSS), proximal humerus ossification system (PHOS) and the thumb ossification composite index (TOCI) as skeletal maturity assessment tools using LDSS.
A survey including 85 LDSS and 42 hand radiographs was administered to four orthopedic clinicians. Each rater assessed the TOCI, SMSS and PHOS stage for each image. Standing LDSS with hands at the patient's side were used for TOCI, SMSS, and PHOS measurements. SMSS and TOCI measurements on dedicated hand radiographs were assessed as a comparison. Interobserver reliability was calculated for each scale using Fleiss' kappa. For SMSS and TOCI, intraobserver correlation between measurements on LDSS and measurements on hand radiographs were also assessed.
472 TOCI measurements, 288 SMSS measurements, and 340 measurements were collected. Kappa interobserver reliability for TOCI was 0.79 (strong) using hand radiographs and 0.74 (strong) using LDSS. Kappa for SMSS was 0.66 (strong) using hand radiographs and 0.45 (moderate) using LDSS. Kappa for PHOS was 0.51 (moderate) using LDSS. Intraobserver agreement between LDSS and hand imaging averaged 0.78 (strong) for TOCI and 0.34 (weak) for SMSS.
Skeletal maturity assessment with TOCI using LDSS demonstrates strong interobserver reliability when hands are placed at the patient's side and correlates well with assessment on hand radiographs. TOCI achieved better inter- and intraobserver reliability compared to SMSS and PHOS, likely because the thumb readily assumes a good position in standing scoliosis sterioradiographs.
Diagnostic-Level III.
使用低剂量脊柱侧凸射线照相术（LDSS）同时对手或近端肱骨进行成像，可能会进行骨骼成熟度评估。我们旨在比较 Sanders 骨骼成熟度分期（SMSS）、近端肱骨骨化系统（PHOS）和拇指骨化综合指数（TOCI）作为使用 LDSS 进行骨骼成熟度评估工具的实用性、可靠性和有效性。
向四名矫形临床医生发放了一项包括 85 张 LDSS 和 42 张手部 X 光片的调查。每位评估者都评估了 TOCI、SMSS 和 PHOS 分期。使用站立位 LDSS 并将手放在患者的侧面来进行 TOCI、SMSS 和 PHOS 测量。专门的手部 X 光片上的 SMSS 和 TOCI 测量被评估为比较。使用 Fleiss' kappa 计算每个量表的观察者间可靠性。对于 SMSS 和 TOCI，还评估了 LDSS 上的测量值与手部 X 光片上的测量值之间的观察者内相关性。
共收集了 472 次 TOCI 测量值、288 次 SMSS 测量值和 340 次 PHOS 测量值。使用手部 X 光片时，TOCI 的观察者间kappa 可靠性为 0.79（强），使用 LDSS 时为 0.74（强）。使用手部 X 光片时，SMSS 的 kappa 为 0.66（强），使用 LDSS 时为 0.45（中度）。使用 LDSS 时，PHOS 的 kappa 为 0.51（中度）。LDSS 与手部成像之间的观察者内一致性平均为 TOCI 的 0.78（强）和 SMSS 的 0.34（弱）。
使用 LDSS 进行 TOCI 的骨骼成熟度评估当手放在患者的侧面时具有很强的观察者间可靠性，并且与手部 X 光片的评估很好地相关。TOCI 与 SMSS 和 PHOS 相比具有更好的观察者间和观察者内可靠性，这可能是因为拇指在站立位脊柱后前位 X 光片中很容易处于良好的位置。
诊断水平 III。
