Chaudhry-Ahlawalia V, Gladman D D, Urowitz M B, Bogoch E, Farewell V T
University of Toronto Rheumatic Disease Unit, Toronto Hospital, Ontario, Canada.
Clin Orthop Relat Res. 1998 Jul(352):131-6.
The purpose of this study was to assess the reliability and accuracy of the modified Marcus and Enneking classification of osteonecrosis of the femoral head in patients with systemic lupus erythematosus when applied to the reading of the original radiographs and then applied to interpreting the radiologist's written report. Thirty anteroposterior radiographs of the hip from patients with systemic lupus erythematosus with varying degrees of osteonecrosis were selected and submitted to a panel of two rheumatologists and an orthopaedic surgeon who individually graded the radiographs using the modified Marcus and Enneking method. Agreement was determined by the kappa statistics. Identical staging was assigned in 21 of the 30 radiographs by all three observers, providing a weighted kappa of 0.88. Identical staging was assigned by all three observers in 26 of the 30 reports, giving a kappa of 0.95. There was agreement in the staging of 23 of the 30 radiographs by actual reading and the radiologist's report, with a weighted kappa of 0.86. Discordant gradings resulted primarily because the Marcus and Enneking method does not account for degenerative changes on the femoral side of the hip joint. The authors conclude that the radiologist's report can be used to stage osteonecrosis when interpreted by expert observers and when those reports contain all critical information required for staging. The authors recommend that the Marcus and Enneking classification be modified to include changes on the femoral side of the joint.
本研究的目的是评估改良的马库斯（Marcus）和恩内金（Enneking）股骨头坏死分类法在系统性红斑狼疮患者中的可靠性和准确性，该分类法用于解读原始X线片，然后用于解读放射科医生的书面报告。从患有不同程度股骨头坏死的系统性红斑狼疮患者中选取了30张髋关节前后位X线片，并提交给由两名风湿病学家和一名骨科医生组成的小组，他们分别使用改良的马库斯和恩内金方法对X线片进行分级。通过kappa统计量确定一致性。所有三名观察者在30张X线片中的21张上给出了相同的分期，加权kappa值为0.88。所有三名观察者在30份报告中的26份上给出了相同的分期，kappa值为0.95。实际读片与放射科医生的报告在30张X线片中的23张分期上达成一致，加权kappa值为0.86。分级不一致主要是因为马库斯和恩内金方法没有考虑髋关节股骨侧的退行性改变。作者得出结论，当由专家观察者解读且报告包含分期所需的所有关键信息时，放射科医生的报告可用于对股骨头坏死进行分期。作者建议对马库斯和恩内金分类法进行修改，以纳入关节股骨侧的改变。
