Watkins Colyn, Lins Laura, Miller Trisha, Matheney Travis, Snyder Brian, Wang Kemble, Graham Kerr, Shore Benjamin
Boston Children's Hospital, Boston, MA.
University of Wisconsin-Madison Department of Orthopedic Surgery, Madison, WI.
J Pediatr Soc North Am. 2024 Feb 12;5(2):595. doi: 10.55275/JPOSNA-2023-595. eCollection 2023 May.
This study investigates surgeon interpretation of intraoperative hip arthrography after femoral osteotomy to guide decision-making regarding addition of concomitant pelvic osteotomy (PO) for Cerebral Palsy (CP) hip reconstruction. Ten orthopaedic surgeons reviewed preoperative radiographic images of 21 children with CP, undergoing hip reconstruction. Surgeons recorded if PO was indicated after 1) reviewing the preoperative radiographs. Raters who exhibited poor reliability (kappas <0.60) were excluded from arthrogram analysis. Agreement in decision-making was evaluated by estimating the concordance across six raters with respect to changing their recommendation after reviewing the arthrogram images by estimating Fleiss's kappa coefficient. Intra-rater reliability for the three surgeons who conducted repeat evaluations was substantial to almost perfect (k=0.67, 0.86, 1.00). Pairwise inter-rater reliability for radiographic decision was moderate to almost perfect with kappa values ranging from 0.56 to 0.87. In 20 of 32 hip evaluations, at least 5 of 6 raters recommended PO after reviewing the radiograph, 64% of the cohort (122/192). However, upon reviewing the arthrogram images, only 45% (86/192) of reviewers recommended a PO. Attending surgeons changed their decisions away from PO in 35% of cases overall while fellows changed their decisions in only 7% of cases. Further radiographic characterization of the labrum position demonstrated substantial agreement (kappa=0.73; 95% CI=0.48-0.98) and almost perfect agreement regarding presence of dye pool (kappa=0.85; 95% CI=0.50-1.00). Interpretation of intraoperative hip arthrography to guide addition of PO in CP hip reconstruction is reliable with moderate agreement according to experience level and with substantial retest reliability. Level IV •Arthrograms can be helpful to determine hip stability during hip reconstruction in cerebral palsy patients.•The reliability of the interpretation of arthrograms is an important area of study.•Decision-making in neuromuscular hip reconstruction is not standardized across surgeons or institutions.
本研究调查了股骨截骨术后外科医生对术中髋关节造影的解读，以指导关于是否增加脑瘫（CP）髋关节重建同期骨盆截骨（PO）的决策。10位骨科医生回顾了21例接受髋关节重建的CP患儿的术前影像学图像。外科医生在1）查看术前X光片后记录是否需要进行PO。可靠性较差（kappa值<0.60）的评估者被排除在造影分析之外。通过估计六位评估者在查看造影图像后改变其建议的一致性，使用Fleiss卡方系数来评估决策的一致性。进行重复评估的三位外科医生的评分者内信度较高至几乎完美（k = 0.67、0.86、1.00）。X光片决策的两两评分者间信度中等至几乎完美，kappa值范围为0.56至0.87。在32例髋关节评估中的20例中，至少6位评估者中有5位在查看X光片后建议进行PO，占队列的64%（122/192）。然而，在查看造影图像后，只有45%（86/192）的评估者建议进行PO。主治医生在总体35%的病例中改变了他们不进行PO的决策，而住院医生仅在7%的病例中改变了他们的决策。对盂唇位置的进一步影像学特征分析显示出较高的一致性（kappa = 0.73；95%CI = 0.48 - 0.98），对于染料池的存在几乎达到完美一致（kappa = 0.85；95%CI = 0.50 - 1.00）。根据经验水平，术中髋关节造影用于指导CP髋关节重建中增加PO的解读具有适度一致性，可靠性较高，重测信度也较高。IV级•造影在脑瘫患者髋关节重建过程中有助于确定髋关节稳定性。•造影解读的可靠性是一个重要的研究领域。•神经肌肉性髋关节重建的决策在不同外科医生或机构之间并不统一。
