Reliability of a New Radiographic Classification for Developmental Dysplasia of the Hip.
Reliability of a New Radiographic Classification for Developmental Dysplasia of the Hip.
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DOI：
10.1097/bpo.0000000000000318
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发表时间：
2015-07
期刊：
影响因子：
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通讯作者：
International Hip Dysplasia Institute
中科院分区：
文献类型：
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作者：
Narayanan U;Mulpuri K;Sankar WN;Clarke NM;Hosalkar H;Price CT;International Hip Dysplasia Institute
DDH的现有影像学分类方案（例如，Tönnis标准）根据骨化核相对于Hilgenreiner线和Perkin线的位置量化疾病的严重程度。根据定义，该方法需要存在骨化中心，其在股骨头内的出现可能延迟并且位置偏心。国际髋关节发育不良研究所（IHDI）开发了一种新的影像学分类系统，该系统使用股骨近端干骺端的中点作为参考标志，因此可适用于所有年龄段的儿童。本研究的目的是比较这种新方法与Tönnis方法的可靠性，作为建立其有效性和临床实用性的第一步。有目的地选择了20例未经治疗的DDH儿童的标准化骨盆前后位X线片，以捕获表现和疾病严重程度的年龄谱（范围，3至32个月）。由来自美国、加拿大、墨西哥、英国的6名经验丰富的儿科骨科医生和2名骨科高级住院医师采用IHDI和Tönnis方法对每个髋关节进行单独分类。使用类内相关系数（ICC）来测量评估者之间的一致性，以测试评估者间的可靠性。所有40个髋关节均由所有评定者通过IHDI方法进行分类。40个髋关节中有10个髋关节无法通过Tönnis方法分类，因为一侧或两侧缺乏骨化核。对于所有评定者，IHDI方法的ICC（95%置信区间）分别为0.90（0.83-0.95）和0.95（0.91-0.98）（右侧和左侧髋关节）。Tönnis方法的相应ICC分别为0.63（0.46-0.80）和0.60（0.43-0.78）。6名专家和2名实习生的ICC无显著差异。IHDI分类方法在专家和新手中具有良好的评分者间可靠性，并且比Tönnis方法适用范围更广，因为即使在骨化中心不存在的情况下也可以应用。二级（诊断）。
Existing radiographic classification schemes (eg, Tönnis criteria) for DDH quantify the severity of disease based on the position of the ossific nucleus relative to Hilgenreiner’s and Perkin’s lines. By definition, this method requires the presence of an ossification centre, which can be delayed in appearance and eccentric in location within the femoral head. A new radiographic classification system has been developed by the International Hip Dysplasia Institute (IHDI), which uses the mid-point of the proximal femoral metaphysis as a reference landmark, and can therefore be applied to children of all ages. The purpose of this study was to compare the reliability of this new method with that of Tönnis, as the first step in establishing its validity and clinical utility. Twenty standardized anteroposterior pelvic radiographs of children with untreated DDH were selected purposefully to capture the spectrum of age (range, 3 to 32 mo) at presentation and disease severity. Each of the hips was classified separately by the IHDI and Tönnis methods by 6 experienced pediatric orthopaedists from the United States, Canada, Mexico, United Kingdom, and by 2 orthopaedic senior residents. The inter-rater reliability was tested using the Intra Class Correlation coefficient (ICC) to measure concordance between raters. All 40 hips were classifiable by the IHDI method by all raters. Ten of the 40 hips could not be classified by the Tönnis method because of the absence of the ossific nucleus on one or both sides. The ICC (95% confidence interval) for the IHDI method for all raters was 0.90 (0.83-0.95) and 0.95 (0.91-0.98) for the right and left hips, respectively. The corresponding ICCs for the Tönnis method were 0.63 (0.46-0.80) and 0.60 (0.43-0.78), respectively. There was no significant difference between the ICCs of the 6 experts and 2 trainees. The IHDI method of classification has excellent inter-rater reliability, both among experts and novices, and is more widely applicable than the Tönnis method as it can be applied even when the ossification centre is absent. Level II (diagnostic).