Sun Ning, Wang Xuewen, Xu Xiangyu, Li Heng, Li Wenjing, Gong Xiaofeng, Du Hui, Wu Yong
Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, No.31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
BMC Musculoskelet Disord. 2024 Dec 19;25(1):1034. doi: 10.1186/s12891-024-08158-7.
Hallux valgus (HV) is a multiplanar deformity and surgical treatment is often guided by two-dimensional radiographic parameters. This study assessed the reliability and accuracy of the AIR classification(The first metatarsal head's lateral edge can be delineated as angular (type A), round (type R), or intermediate (type I) through visual inspection or circle measurements on weight-bearing radiographs.)commonly used in clinical settings to categorize the shape of the lateral edge of the first metatarsal head, against measurements from weight-bearing computed tomography (WBCT).
This retrospective study evaluated 18 patients, including 31 feet affected by HV. Two surgeons independently categorized the first metatarsal head's lateral edge by both visual inspection and circle measurement. Additionally, two separate surgeons evaluated the α angle relative to the floor in WBCT scans. The reliability of the measurements was assessed using intraclass correlation coefficients (ICC) and weighted kappa statistics.
While the first surgeon demonstrated perfect intra-observer reliability for both visual inspection and circular measurements (kappa values of 1.000 and 0.857, respectively), the second surgeon showed high and perfect reliability (kappa values of 0.759 and 1.000, respectively) for the same assessments. While the interobserver reliability for visual inspection was moderate (kappa values of 0.407 and 0.455, respectively), it was little to low for circular measurements (kappa values of 0.173 and 0.232, respectively). The interobserver reliability for the α angle assessment relative to the floor on WBCT scans was perfect (ICC = 0.968).
The AIR classification may not provide a reliable estimate of first metatarsal pronation, so clinicians should be cautious and recognize these limitations in their diagnostic applications. Between the two AIR classifications, the visual inspection measurement seems to be more reliable according to kappa value. If allowed, it may be better to additionally include a 3D assessment method such as WBCT, in the preoperative evaluation.
IV, case series.
拇外翻（HV）是一种多平面畸形，手术治疗通常由二维影像学参数指导。本研究评估了临床常用的AIR分类法（通过负重X线片上的目视检查或圆测量，可将第一跖骨头的外侧边缘描绘为角形（A型）、圆形（R型）或中间型（I型））对第一跖骨头外侧边缘形状分类的可靠性和准确性，并与负重计算机断层扫描（WBCT）测量结果进行对比。
本回顾性研究评估了18例患者，包括31只受HV影响的脚。两名外科医生通过目视检查和圆测量对第一跖骨头的外侧边缘进行独立分类。此外，另外两名外科医生在WBCT扫描中评估相对于地面的α角。使用组内相关系数（ICC）和加权kappa统计量评估测量的可靠性。
虽然第一位外科医生在目视检查和圆形测量中均表现出完美的观察者内可靠性（kappa值分别为1.000和0.857），但第二位外科医生在相同评估中表现出高可靠性和完美可靠性（kappa值分别为0.759和1.000）。虽然目视检查的观察者间可靠性中等（kappa值分别为0.407和0.455），但圆形测量的观察者间可靠性较低（kappa值分别为0.173和0.232）。WBCT扫描中相对于地面的α角评估的观察者间可靠性完美（ICC = 0.968）。
AIR分类法可能无法提供第一跖骨内旋的可靠估计，因此临床医生在诊断应用中应谨慎并认识到这些局限性。在两种AIR分类法中，根据kappa值，目视检查测量似乎更可靠。如果条件允许，在术前评估中最好额外纳入一种三维评估方法，如WBCT。
IV，病例系列。
