The oblique plane deformity in slipped capital femoral epiphysis.
The oblique plane deformity in slipped capital femoral epiphysis.
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DOI：
10.1007/s11832-014-0559-2
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发表时间：
2014-03
影响因子：
1.4
通讯作者：
Madan, Sanjeev S
中科院分区：
文献类型：
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作者：
Cooper, Anthony Philip;Salih, Saif;Geddis, Carolyn;Foster, Patrick;Fernandes, James A;Madan, Sanjeev S
股骨头骨骺滑脱（SCFE）通常采用原位钉固定治疗。然而，严重滑脱可能不适合原位固定，因为所需的螺钉轨迹可能会穿透后皮质并损坏头骨骺的剩余血液供应。在这种情况下，前方放置的螺钉也可能导致撞击。使用传统的X光片也可能低估滑脱的严重程度。本研究的目的是描述和评价一种计算SCFE真实畸形的新方法，并评估该技术的观察者间和观察者内可靠性。我们选择了20例不同严重程度的SCFE患者，他们到我们的机构就诊。横断面成像[轴向计算机断层扫描（CT）或磁共振成像（MRI）扫描]和前后位（AP）骨盆X线片由4名经验水平不同的评审员在两种情况下进行评估。测量轴位图像和骨盆正位片上的滑动程度，并据此使用Paley推广的方法计算斜平面畸形。计算组内相关系数（ICC），以确定评估者之间的观察者间和观察者内的可靠性。SCFE ICC中计算的斜面畸形的观察者间可靠性为0.947 [95%置信区间（CI）0.90-0.98]，个体评定者计算的斜面畸形的观察者内可靠性范围为0.81 - 0.94。倾斜平面的畸形总是大于单独在轴向或冠状面测量的畸形。这种计算SCFE真实畸形的方法具有良好的观察者间和观察者内可靠性，可用于指导治疗方案。这项技术是一种可靠的和可重复的方法来评估畸形的程度在SCFE。它可以帮助具有不同经验的骨科医生确定哪些髋关节适合原位钉扎，哪些髋关节需要手术脱位和解剖复位，因为单平面X线平片会低估斜平面的真实畸形。二级诊断研究。
Slipped capital femoral epiphysis (SCFE) is commonly treated with in situ pinning. However, a severe slip may not be suitable for in situ pinning because the required screw trajectory is such that it risks perforating the posterior cortex and damaging the remaining blood supply to the capital epiphysis. In such cases, an anteriorly placed screw may also cause impingement. It is also possible to underestimate the severity of the slip using conventional radiographs. The aim of this study was to describe and evaluate a novel method for calculating the true deformity in SCFE and to assess the interobserver and intraobserver reliability of this technique. We selected 20 patients with varying severity of SCFE who presented to our institution. Cross-sectional imaging [either axial computed tomography (CT) scans or magnetic resonance imaging (MRI) scans] and anteroposterior (AP) pelvis radiographs were assessed by four reviewers with varying levels of experience on two occasions. The degree of slip on the axial image and on the AP pelvis radiographs were measured and, from this, the oblique plane deformity was calculated using the method as popularised by Paley. The intraclass correlation coefficient (ICC) was calculated to determine the interobserver and intraobserver reliabilities between and amongst the raters. The interobserver reliability for the calculated oblique plane deformity in SCFE ICC was 0.947 [95 % confidence interval (CI) 0.90–0.98] and the intraobserver reliability for the calculated oblique plane deformity of individual raters ranged from 0.81 to 0.94. The deformity in the oblique plane was always greater than the deformity measured in the axial or the coronal plane alone. This method for calculating the true deformity in SCFE has excellent interobserver and intraobserver reliability and can be used to guide treatment options. This technique is a reliable and reproducible method for assessing the degree of deformity in SCFE. It may help orthopaedic surgeons with varying degrees of experience to identify which hips are suitable for in situ pinning and those which require surgical dislocation and anatomical reduction, given that plain radiographs in a single plane will underestimate the true deformity in the oblique plane. Level II diagnostic study.