Interobserver and Intraobserver Reliability of the Radiographic Analysis of Femoroacetabular Impingement and Dysplasia Using Computer-Assisted Measurements
Interobserver and Intraobserver Reliability of the Radiographic Analysis of Femoroacetabular Impingement and Dysplasia Using Computer-Assisted Measurements
复制标题
DOI：
10.1177/0363546514542797
复制
发表时间：
2014-10-01
影响因子：
4.8
通讯作者：
Clohisy, John C.
中科院分区：
文献类型：
--
作者：
Nepple, Jeffrey J.;Martell, John M.;Clohisy, John C.
背景：对髋关节疼痛的年轻成人进行髋关节X线片的综合评价变得越来越复杂和耗时。人工测量股骨髋臼撞击（包括α角）的观察者间可靠性受到质疑。提高影像学评价可靠性的方法可能会增加这些参数的临床实用性。目的：确定在临床相关环境中年轻成人髋关节计算机辅助影像学分析的观察者间和观察者内可靠性。研究设计：队列研究证据等级：3.方法：进行了全面的计算机辅助放射学评价的可靠性研究，其中包括股骨近端形态、髋臼形态、髋关节骨关节炎，和骨盆倾斜/旋转。纳入了70例接受髋关节保留手术的连续患者的骨盆前后位和45度Dunn侧位X线片。由4名经验丰富的髋关节外科医生对每张X线片进行分析。连续测量的可靠性进行了分析，使用组内相关系数（ICCs），而分类参数进行了分析，使用值和百分比agreement.Results：观察者间的可靠性股骨近端形态，髋臼形态，骨关节炎的参数一般是实质性的优秀。观察者间可靠性较低的参数包括α角（ICC，0.43），Tonnis骨关节炎分类（= 0.22），骨盆倾斜分类（使用尾骨或骶尾骨关节）（分别为0.43和0.61）。一台电脑-对年轻成人髋关节X线片的辅助分析通常表明，大多数参数的观察者间可靠性水平相当高。然而，尽管观察者内可靠性很好，α角测量仅显示中等的观察者间可靠性。在该人群中，关节间隙宽度的测量似乎比使用Tonnis骨关节炎分类更可靠。利用尾骨或骶尾骨关节对骨盆倾斜进行分类的可靠性不高。
Background: A comprehensive evaluation of hip radiographs in the young adult with hip pain has become increasingly complex and time consuming. The interobserver reliability of manually performed measurements of femoroacetabular impingement, including the alpha angle, has been questioned. Methods to improve the reliability of a radiographic evaluation may increase the clinical utility of these parameters.Purpose: To determine the interobserver and intraobserver reliability of a computer-assisted radiographic analysis of the young adult hip in a clinically relevant setting.Study Design: Cohort study (diagnosis); Level of evidence, 3.Methods: A reliability study of a comprehensive computer-assisted radiographic evaluation was performed, which included 25 radiographic parameters of proximal femoral morphology, acetabular morphology, hip osteoarthritis, and pelvic tilt/rotation. Anteroposterior pelvis and 45 degrees Dunn lateral radiographs of 70 consecutive patients undergoing hip preservation surgery were included. Each radiograph was analyzed by 4 experienced hip surgeons. The reliability of continuous measurements was analyzed using intraclass correlation coefficients (ICCs), while categorical parameters were analyzed using values and percentages of agreement.Results: The interobserver reliability of the parameters of proximal femoral morphology, acetabular morphology, and osteoarthritis was generally substantial to excellent. Parameters with lesser interobserver reliability included the alpha angle (ICC, 0.43), Tonnis osteoarthritis classification ( = 0.22), and classification of pelvic tilt (using the coccyx or sacrococcygeal joint) ( = 0.43 and 0.61, respectively).Conclusion: A computer-assisted analysis of young adult hip radiographs generally demonstrates substantial to excellent levels of interobserver reliability for most parameters. However, alpha angle measurements demonstrated only moderate interobserver reliability, despite excellent intraobserver reliability. Measurements of the joint space width appear to be significantly more reliable than the use of the Tonnis osteoarthritis classification in this population. The classification of pelvic tilt utilizing the coccyx or sacrococcygeal joint is only moderately reliable.