Grünwald Leonard, Nejima Shuntaro, Histing Tina, Schröter Steffen, Hagedorn Peter
Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.
Osteotomie Komitee der Deutschen Kniegesellschaft, München, Germany.
Knee Surg Sports Traumatol Arthrosc. 2025 Jun;33(6):2095-2103. doi: 10.1002/ksa.12509. Epub 2024 Oct 21.
The aim of this study was to evaluate a software-based measurement tool of computed tomography imaging to assess torsional alignment of the lower limb-usually used for patients with posttraumatic deformities and patellofemoral issues-and compare these measurements with manual measurements of two experienced raters.
This study was a retrospective analysis of 58 lower limbs (47 patients, 20 men and 27 women) aged between 19 and 97 years. Inclusion criteria were the clinical indication for torsion measurement of the lower limb. Legs with incomplete imaging and age less than 18 years were excluded. Femoral and tibial torsion were measured separately. Torsional alignment was assessed software-based at two time points by two raters. Rater one additionally assessed manual-based measurement at two time points. The software used was mediCAD 3D Knee Version 2.5.33 (Hectec). Subsequently, intra- and inter-rater reliability was calculated using the intraclass correlation coefficient (ICC). Validity testing was performed by means of precision, concordance correlation coefficient according to Lin (ccc) and Pearson correlation coefficient.
High intra-rater reliability for software-based as well as manual-based evaluation of torsional alignment was found for the tibia as well as the femur (ICC ranging between 0.870 and 0.993). Inter-rater reliability also showed highly significant results of both manual and software-based measurements (ICC ranging between 0.851 and 0.993). For almost all comparisons (except the tibia left), software-based measurements showed higher ICC scores above 0.9, and, therefore, classified as 'excellent reliability'. For validity testing, correlation coefficients and precision showed very good correspondence of the measurements (all values > 0.9), without systematic deviations.
Software-based measurement of torsional alignment according to the measurement method developed by H.-A. Waidelich proved to be a reliable and valid technique. Especially for inexperienced surgeons, software-based measurement, therefore, might improve confidence in reliable medical decisions in diagnostics and treatment.
Level III.
本研究旨在评估一种基于软件的计算机断层扫描成像测量工具，以评估下肢的扭转对线情况（通常用于创伤后畸形和髌股问题患者），并将这些测量结果与两名经验丰富的评估者的手动测量结果进行比较。
本研究是对58例年龄在19至97岁之间的下肢（47例患者，20例男性和27例女性）进行的回顾性分析。纳入标准为下肢扭转测量的临床指征。排除成像不完整和年龄小于18岁的腿部。分别测量股骨和胫骨扭转。两名评估者在两个时间点基于软件评估扭转对线情况。评估者一还在两个时间点评估基于手动的测量。使用的软件是mediCAD 3D Knee版本2.5.33（Hectec）。随后，使用组内相关系数（ICC）计算评估者内和评估者间的可靠性。通过精度、根据林氏法计算的一致性相关系数（ccc）和皮尔逊相关系数进行效度测试。
在胫骨和股骨的扭转对线基于软件以及基于手动的评估中，均发现评估者内可靠性较高（ICC范围在0.870至0.993之间）。评估者间可靠性在手动和基于软件的测量中也显示出高度显著的结果（ICC范围在0.851至0.993之间）。对于几乎所有比较（除了左侧胫骨），基于软件的测量显示ICC得分高于0.9，因此被归类为“可靠性极佳”。对于效度测试，相关系数和精度显示测量结果具有很好的一致性（所有值均>0.9），无系统偏差。
根据H.-A. Waidelich开发的测量方法，基于软件的扭转对线测量被证明是一种可靠且有效的技术。因此，特别是对于经验不足的外科医生，基于软件的测量可能会提高他们在诊断和治疗中做出可靠医疗决策的信心。
三级。
