Wright J G, Moran E, Bogoch E
Division of Orthopaedic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
J Arthroplasty. 1994 Oct;9(5):549-53. doi: 10.1016/0883-5403(94)90104-x.
The purpose of this study is to assess the reliability and validity of the Brooker grading of heterotopic ossification. Anteroposterior hip radiographs of 77 patients, taken 6 months following total hip arthroplasty, were blindly evaluated twice by two surgeons using the Brooker scale. Patients were also evaluated with the Harris hip scale, and range of motion of the hip was determined. All inconsistencies in heterotopic ossification grading were reviewed by the same two surgeons who developed six points of clarification to minimize ambiguities in the Brooker grading criteria. A second set of 76 radiographs were reviewed by the two surgeons using this modified Brooker index. The intraobserver reliability of the two readers was good, with agreements of 77 and 86% and weighted kappa values of 0.63 and 0.69, respectively. The two surgeons demonstrated fair interobserver reliability on the first reading (agreement of 68% and weighted kappa of 0.57) that improved to a good level of reliability (agreement of 77% and weighted kappa of 0.68) using the revised Brooker index. The grade of heterotopic ossification was correlated (r = -.25, P = .005) with the aggregate range of hip motion, but had no relationship to the patient's Harris rating. In conclusion, the grading of heterotopic ossification is reliable. Although the severity of heterotopic ossification did not correlate with the Harris scale, the relationship between heterotopic ossification and range of motion indicates that the Brooker index is also a valid measurement.
本研究的目的是评估异位骨化的布鲁克分级的可靠性和有效性。对77例患者全髋关节置换术后6个月的前后位髋关节X线片，由两位外科医生使用布鲁克量表进行两次盲法评估。患者还接受了Harris髋关节评分，并测定了髋关节活动范围。异位骨化分级中的所有不一致情况由同两位外科医生进行复查，他们制定了六点说明以尽量减少布鲁克分级标准中的模糊性。两位外科医生使用这个改良的布鲁克指数对另一组76张X线片进行了复查。两位阅片者的观察者内可靠性良好，一致性分别为77%和86%，加权kappa值分别为0.63和0.69。两位外科医生在首次阅片时观察者间可靠性一般（一致性为68%，加权kappa为0.57），使用修订后的布鲁克指数后提高到良好的可靠性水平（一致性为77%，加权kappa为0.68）。异位骨化分级与髋关节活动总范围相关（r = -0.25，P = 0.005），但与患者的Harris评分无关。总之，异位骨化分级是可靠的。虽然异位骨化的严重程度与Harris量表不相关，但异位骨化与活动范围之间的关系表明布鲁克指数也是一种有效的测量方法。
