Lim Kevin B L, Lee Nicole K L, Yeo Beatrice S, Lim Victoria M M, Ng Stacy W L, Mishra Neeraj
Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Singapore.
Division of Surgery, KK Women's and Children's Hospital, Singapore, Singapore.
Bone Jt Open. 2023 Sep 7;4(9):689-695. doi: 10.1302/2633-1462.49.BJO-2023-0057.R1.
To determine whether side-bending films in scoliosis are assessed for adequacy in clinical practice; and to introduce a novel method for doing so.
Six surgeons and eight radiographers were invited to participate in four online surveys. The generic survey comprised erect and left and right bending radiographs of eight individuals with scoliosis, with an average age of 14.6 years. Respondents were asked to indicate whether each bending film was optimal (adequate) or suboptimal. In the first survey, they were also asked if they currently assessed the adequacy of bending films. A similar second survey was sent out two weeks later, using the same eight cases but in a different order. In the third survey, a guide for assessing bending film adequacy was attached along with the radiographs to introduce the novel T1-45B method, in which the upper endplate of T1 must tilt ≥ 45° from baseline for the study to be considered optimal. A fourth and final survey was subsequently conducted for confirmation.
Overall, 12 (86%) of 14 respondents did not use any criteria to assess the bending film adequacy; the remaining two each described a different invalidated method. In total, 12 (86%) of the respondents felt T1-45B was easy to learn and apply. There was fair to substantial intra-rater reliability (k = 0.25 to 0.88) which improved to fair to almost perfect (k = 0.38 to 0.88) post-introduction of the guide. Inter-rater reliability varied considerably among the rater groups but similarly increased following introduction of the guide (k = 0.19 to 0.34, k = 0.33 to 0.43 vs k = 0.49 to 0.5, k = 0.35 to 0.43).
Many surgeons and radiographers do not assess spinal bending films for adequacy. We propose that the change in the plane of the upper endplate of T1 on side-bending can be used in this evaluation. In the T1-45B method, a change of ≥ 45° on side bending qualifies as an adequate bend effort.
确定在临床实践中是否会评估脊柱侧弯的侧弯位片是否足够；并介绍一种新的评估方法。
邀请6名外科医生和8名放射技师参与4次在线调查。一般调查包括8名脊柱侧弯患者的直立位以及左、右侧弯位X线片，患者平均年龄为14.6岁。要求受访者指出每张侧弯位片是最佳的（足够的）还是次优的。在第一次调查中，还询问他们目前是否评估侧弯位片的充分性。两周后发出类似的第二次调查，使用相同的8个病例，但顺序不同。在第三次调查中，随X线片附上一份评估侧弯位片充分性的指南，以介绍新的T1 - 45B方法，即T1的上终板必须相对于基线倾斜≥45°，该研究才被视为最佳。随后进行第四次也是最后一次调查以进行确认。
总体而言，14名受访者中有12名（86%）未使用任何标准来评估侧弯位片的充分性；其余两人各自描述了一种不同的无效方法。总共12名（86%）受访者认为T1 - 45B易于学习和应用。评分者内信度为一般到较高（k = 0.25至0.88），在引入指南后提高到一般到几乎完美（k = 0.38至0.88）。评分者间信度在不同评分者组之间差异很大，但在引入指南后同样有所提高（k = 0.19至0.34，k = 0.33至0.43对比k = 0.49至0.5，k = 0.35至0.43）。
许多外科医生和放射技师不评估脊柱侧弯位片是否足够。我们建议，可以使用T1侧弯时上终板平面的变化来进行此评估。在T1 - 45B方法中，侧弯时变化≥45°被视为足够的侧弯力度。
