脑瘫儿童骨盆 X 线片：患者体位对计算移位百分比的影响。
Pelvis radiographs in children with cerebral palsy: effects of patient positioning on calculating migration percentages.
机构信息
Divisions of Pediatric Radiology and Musculoskeletal Radiology, Weill Cornell Medical School, New York, NY, USA.
Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
出版信息
Pediatr Radiol. 2023 Dec;53(13):2662-2671. doi: 10.1007/s00247-023-05783-7. Epub 2023 Oct 14.
BACKGROUND
Hip displacement in children with cerebral palsy (CP) is monitored by measuring migration percentage on anteroposterior pelvis radiographs. However, proper positioning for radiography in children with spasticity is difficult. The reliability and accuracy of migration percentage as a function of patient positioning is unknown.
OBJECTIVE
To determine the effects of patient positioning on migration percentage measurements in children with CP.
MATERIALS AND METHODS
We identified children with CP (≤18-year-old) with pelvis CT and anteroposterior pelvis radiograph obtained <6 months apart (10/2018-11/2021). Digitally reconstructed radiographs were generated from each pelvis CT, to simulate nine different patient positions: neutral; 10° and 20° lordosis and kyphosis; and 10° and 20° right rotation and left rotation. Two radiologists measured migration percentages from the simulated and real pelvis radiographs. We used Spearman's rho to assess inter-rater reliability, and Wilcoxon signed rank test to determine statistical significance.
RESULTS
We studied sixty-three children (male=41; median age=8 years; range=4-18 years). The two radiologists' migration percentage measurements were highly correlated with each other across all simulated and real radiographs (Spearman's rho=0.86-0.99, P<0.01). For both readers and hips, migration percentages measured from real radiographs were significantly different from those measured from neutral simulated radiographs (P<0.01), with median absolute difference=5-6 percentage points (PP) and interquartile range (IQR)=9-12 PP. When comparing migration percentage measurements from neutral simulated radiographs to those in kyphosis/lordosis and right/left rotations, median absolute differences were 2-4 PP (IQR=3-8 PP) and 4-15 PP (IQR=6-17 PP), respectively.
CONCLUSION
Inter-rater reliability of measured migration percentages is high, but accuracy decreases with patient positional changes.
背景
脑瘫（CP）患儿髋关节位移通过测量前后骨盆 X 线片上的迁移百分比来监测。然而，痉挛患儿的 X 线摄影正确定位较为困难。患者体位对迁移百分比的影响的可靠性和准确性尚不清楚。
目的
确定患者体位对 CP 患儿迁移百分比测量的影响。
材料和方法
我们确定了骨盆 CT 和前后骨盆 X 线片在 <6 个月内获得的≤18 岁 CP 患儿（2018 年 10 月至 2021 年 11 月）。从每个骨盆 CT 生成数字重建射线照片，以模拟九种不同的患者体位：中立位；10°和 20°前凸和后凸；以及 10°和 20°右旋和左旋。两名放射科医生从模拟和真实骨盆 X 线片中测量迁移百分比。我们使用 Spearman's rho 评估评分者间可靠性，Wilcoxon 符号秩检验确定统计学意义。
结果
我们研究了 63 名儿童（男性=41 名；中位年龄=8 岁；范围=4-18 岁）。两位放射科医生的迁移百分比测量值在所有模拟和真实射线照片上彼此高度相关（Spearman's rho=0.86-0.99，P<0.01）。对于两位读者和所有髋关节，从真实 X 线片测量的迁移百分比与从中立模拟 X 线片测量的迁移百分比有显著差异（P<0.01），中位数绝对差异=5-6 个百分点（PP），四分位距（IQR）=9-12 PP。当将从中立模拟射线片中测量的迁移百分比与后凸/前凸和右/左旋的测量值进行比较时，中位数绝对差异分别为 2-4 PP（IQR=3-8 PP）和 4-15 PP（IQR=6-17 PP）。
结论
测量的迁移百分比的评分者间可靠性很高，但准确性随患者体位变化而降低。
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