Wang Huan, Lu Qing-da, Liu Chen-Xin, Yang Shuai, Qi Bo-Hai, Bai Huan-An, Qu Ji-Ning, Yang Ye, Jin Xiao-Hui, Yang Ming, Su Fei, Yang Ya-Ting, Jie Qiang
Pediatric Orthopedic Hospital, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
Department of Pediatric Surgery, Baoji Maternal and Child Health Care Hospital, Baoji, China.
Front Pediatr. 2023 Mar 9;11:1131618. doi: 10.3389/fped.2023.1131618. eCollection 2023.
Skeletal maturity can evaluate the growth and development potential of children and provide a guide for the management of adolescent idiopathic scoliosis (AIS). Recent studies have demonstrated the advantages of the Humeral Head Ossification System (HHOS) and the Proximal Femur Maturity Index (PFMI), based on standard scoliosis films, in the management of AIS patients. We further assessed the HHOS and the PFMI method's reliability in the interrater and intrarater.
The data from 38 patients, including the humeral head and proximal femur on standard scoliosis films, were distributed to the eight raters in the form of a PowerPoint presentation. On 38 independent standard spine radiographs, raters utilized the HHOS and PFMI to assign grades. The PPT sequence was randomly changed and then reevaluated 2 weeks later. For every system, the 95% confidence interval (95% CI) and intraclass correlation coefficient (ICC) were calculated to evaluate the interrater and intrarater reliability.
The HHOS was extremely reliable, with an intraobserver ICC of 0.802. In the first round, the interobserver ICC reliability for the HHOS was 0.955 (0.929-0.974), while in the second round, it was 0.939 (0.905-0.964). The PFMI was extremely reliable, with an intraobserver ICC of 0.888. In the first round, the interobserver ICC reliability for the PFMI was 0.967 (0.948-0.981), while in the second round, it was 0.973 (0.957-0.984).
The HHOS and PFMI classifications had excellent reliability. These two methods are beneficial to reduce additional exposure to radiation and expense for AIS. There are advantages and disadvantages to each classification. Clinicians should choose a personalized and reasonable method to assess skeletal maturity, which will assist in the management of adolescent scoliosis patients.
骨骼成熟度可评估儿童的生长发育潜力，并为青少年特发性脊柱侧凸（AIS）的治疗提供指导。最近的研究表明，基于标准脊柱侧凸X线片的肱骨头骨化系统（HHOS）和股骨近端成熟指数（PFMI）在AIS患者的治疗中具有优势。我们进一步评估了HHOS和PFMI方法在不同评估者之间以及同一评估者内部的可靠性。
将38例患者标准脊柱侧凸X线片上的肱骨头和股骨近端数据以PowerPoint演示文稿的形式分发给8名评估者。在38张独立的标准脊柱X线片上，评估者使用HHOS和PFMI进行分级。PPT顺序随机更改，2周后重新评估。对于每个系统，计算95%置信区间（95%CI）和组内相关系数（ICC）以评估不同评估者之间以及同一评估者内部的可靠性。
HHOS具有极高的可靠性，观察者内ICC为0.802。在第一轮中，HHOS的观察者间ICC可靠性为0.955（0.929 - 0.974），而在第二轮中为0.939（0.905 - 0.964）。PFMI具有极高的可靠性，观察者内ICC为0.888。在第一轮中，PFMI的观察者间ICC可靠性为0.967（0.948 - 0.981），而在第二轮中为0.973（0.957 - 0.984）。
HHOS和PFMI分类具有出色的可靠性。这两种方法有助于减少AIS患者额外的辐射暴露和费用。每种分类都有优缺点。临床医生应选择个性化且合理的方法来评估骨骼成熟度，这将有助于青少年脊柱侧凸患者的治疗。
