Cicuttini F M, Baker J, Hart D J, Spector T D
Department of Rheumatology, St Thomas' Hospital, London, United Kingdom.
Ann Rheum Dis. 1996 Feb;55(2):134-6. doi: 10.1136/ard.55.2.134.
To assess the reproducibility of different methods of radiological assessment of patellofemoral osteoarthritis (OA) and to determine which is the best view as a research tool in epidemiological studies of knee OA requiring explicit diagnostic criteria to classify the disease in the general population.
A population based study of 252 unrelated, normal individuals (504 knees) was performed. Lateral and skyline radiographs from each individual were graded for joint space narrowing and osteophytes using a standard atlas. Reproducibility was assessed by two observers on 50 knees. Radiographic features were assessed on their ability to predict knee pain.
The skyline views performed better than the lateral views in the assessment of patellofemoral joint OA. The reproducibility for osteophytes was high (kappa > 0.8) and that for joint space narrowing moderate (kappa > 0.6) for both lateral and skyline views. Although the specificity for detecting knee pain was similar in both views, the sensitivity of skyline views in the assessment of knee pain was greater (52.8% versus 30%). The odds ratio for skyline osteophytes as a predictor of knee pain was 7.66 (95% confidence interval (CI) 3.68 to 15.90); that for osteophytes seen on lateral view was 1.83 (95% CI 0.96 to 3.49). Narrowing on both views was a poor predictor of pain. There was frequent disagreement between the lateral and skyline views for detecting osteophytes.
In a community based study, skyline views performed better than lateral views in terms of reproducibility and for identifying symptomatic patellofemoral joint OA. Skyline radiographs should be the preferred method for examining the patellofemoral joint in such studies.
评估不同方法对髌股关节骨关节炎（OA）进行放射学评估的可重复性，并确定在需要明确诊断标准以对普通人群中的疾病进行分类的膝关节OA流行病学研究中，哪种视图作为研究工具是最佳的。
对252名无亲属关系的正常个体（504个膝关节）进行了基于人群的研究。使用标准图谱对每个个体的侧位和天际线X线片进行关节间隙变窄和骨赘分级。两名观察者对50个膝关节进行了可重复性评估。评估了放射学特征预测膝关节疼痛的能力。
在髌股关节OA的评估中，天际线视图比侧位视图表现更好。对于骨赘，侧位和天际线视图的可重复性都很高（kappa>0.8），对于关节间隙变窄，可重复性中等（kappa>0.6）。虽然两种视图检测膝关节疼痛的特异性相似，但天际线视图在评估膝关节疼痛方面的敏感性更高（52.8%对30%）。天际线骨赘作为膝关节疼痛预测指标的优势比为7.66（95%置信区间（CI）3.68至15.90）；侧位视图上可见的骨赘的优势比为1.83（95%CI 0.96至3.49）。两种视图上的间隙变窄对疼痛的预测性较差。在检测骨赘方面，侧位和天际线视图之间经常存在分歧。
在基于社区的研究中，就可重复性和识别有症状的髌股关节OA而言，天际线视图比侧位视图表现更好。在这类研究中，天际线X线片应是检查髌股关节的首选方法。
