Alam Desiree, Hallit Souheil, Mandour Joseph, El Tannoury Boutros, Hassoun Anthony, Bou Haidar Patrick Sami, El Hajj Moussa Majd, Lahoud Jean-Claude, Tawk Charbel, Hoyek Fadi
School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon.
Department of Psychology, College of Humanities, Effat University, Jeddah, Saudi Arabia.
PLoS One. 2025 Aug 14;20(8):e0329230. doi: 10.1371/journal.pone.0329230. eCollection 2025.
Developmental Dysplasia of the hip (DDH) is a common pediatric disorder screened for by antero-posterior (AP) pelvic radiographs in infants aged between 4-9 months. We chose from the radiographic indicators commonly used in the diagnosis the acetabular index, the Shenton line and the ossification and symmetry of the femoral head to assess for their reliability and variability among readers. In addition, this study aimed to obtain the mean age of appearance of the ossification center of the femoral head in the Lebanese population.
149 pelvic AP radiographs of children between 4 and 9 months of age were collected. The criteria were assessed by three experienced readers: one orthopedic surgery fellow resident, one first-year and one second-year orthopedic surgery residents twice separated by a three-month interval.
The bivariate analyses found a difference in the right Acetabular angle and left Acetabular angle significantly in the first- and second-year resident with a p < 0.01. No significant difference was found when comparing the readings of each reader independently for the other variables or with the fellow. We found a significant difference p = 0.047 when comparing the readings of the first-year resident and the fellow of the right AI. Whereas the left AI readings revealed significant differences between the fellow and the second-year resident (p = 0.008) and between the first and second-year residents (p < 0.001). Inter and intrareader consistency was high for the Shenton line rupture and the appearance of the ossification center on the femoral head but none of the parameters proved sufficient to significantly be associated with an acetabular angle> 30°. The average age of ossification center appearance in the Lebanese population was determined to be 5.57 months, aligning with global averages.
These findings call for a diagnostic approach that integrates multiple parameters and focuses on the importance of standardized training to enhance the consistency of radiographic assessments. Further investigations should aim to establish more precise protocols and evaluate the diagnostic strength of individual parameters.
发育性髋关节发育不良（DDH）是一种常见的儿科疾病，通常通过对4至9个月大婴儿的前后位（AP）骨盆X光片进行筛查。我们从诊断中常用的影像学指标中选择髋臼指数、Shenton线以及股骨头的骨化和对称性，以评估它们在不同读者之间的可靠性和变异性。此外，本研究旨在得出黎巴嫩人群中股骨头骨化中心出现的平均年龄。
收集了149张4至9个月大儿童的骨盆APX光片。由三位经验丰富的读者评估这些标准：一位骨科手术住院医师、一位第一年和一位第二年的骨科手术住院医师，两次评估间隔三个月。
双变量分析发现，第一年和第二年住院医师对右侧髋臼角和左侧髋臼角的测量存在显著差异，p < 0.01。在独立比较每位读者对其他变量的读数或与住院医师的读数时，未发现显著差异。比较第一年住院医师和住院医师对右侧髋臼指数的读数时，我们发现存在显著差异，p = 0.047。而左侧髋臼指数读数显示住院医师与第二年住院医师之间存在显著差异（p = 0.008），第一年和第二年住院医师之间也存在显著差异（p < 0.001）。对于Shenton线中断和股骨头骨化中心的出现，读者间和读者内的一致性较高，但没有一个参数足以显著地与髋臼角> 30°相关。黎巴嫩人群中骨化中心出现的平均年龄确定为5.57个月，与全球平均水平一致。
这些发现呼吁采用一种整合多个参数的诊断方法，并强调标准化培训对于提高影像学评估一致性的重要性。进一步的研究应旨在建立更精确的方案，并评估各个参数的诊断强度。
