Severin分级系统：使用数字X线照相、计算机辅助测量工具和Severin算法测量外侧中心边缘角

使用数字X线照相、计算机辅助测量工具和Severin算法测量外侧中心边缘角和确定Severin分级系统：重新审视观察者内和观察者之间的可靠性：2011年J Pediatr Orthop

先天性髋臼发育不良，先天性髋关节半脱位，先髋，DDH

作者：Kristen L Carroll, Kathleen A Murray, Lynne M MacLeod, Theresa A Hennessey, Marcella R Woiczik, James W Roach.

作者单位: Salt Lake City Shrine Hospital for Children, Fairfax at Virginia, USA.

译者：陶可（北京大学人民医院骨关节科）

摘要

背景：大量研究强调了外侧中心边缘角(CEA)和使用X线片测量的Severin分类的观察者内和观察者间可靠性较差。在这项研究中，经验丰富的观察者应用计算机辅助测量程序来确定先前接受过髋关节发育不良(DDH)治疗的成人数字骨盆X线片中的CEA。使用Severin分类的教具/算法，观察者随后为这些髋关节分配了Severin等级。然后根据CEA测量和Severin分类计算观察者内和观察者之间误差。

方法：4名儿科整形外科医生和1名儿科放射科医生使用OrthoView TM计划系统计算CEA，然后在41张盲法数字骨盆X线片上确定Severin分类。每位检查员对X线片进行两次评估，评估相隔2个月。所有考官在进行Severin分类系统之前都审查了Severin分类算法。CEA和Severin分类的观察者内和观察者之间可靠性分别使用类间相关系数和Cohen和Fleiss κ评分计算。

结果：CEA测量的观察者内和观察者之间信度中等至近乎完美。当我们将Severin分类分为3个临床相关组：良好（Severin I和II）、发育不良（Severin III）和差（Severin IV及以上）时，我们的观察者间可靠性几乎接近完美。

结论：Severin分类对于DDH治疗的成功是非常有用且经常使用的放射学测量方法。我们的研究发现，数字X线照相术、计算机辅助测量工具、Severin算法的使用以及将Severin分类分为3个临床相关组显着提高了CEA和Severin分类的观察者内部和观察者之间的可靠性。这一发现将有助于未来使用CEA和Severin分类对DDH治疗结果进行放射学评估的研究。

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FIGURE 1. The center edge angle is measured on a patient with bilateral Severin III hips using the assistance of the Mose concentric circles and angle measurement tools contained in the OrthoView TM software.

图1.在OrthoView TM软件中包含的Mose同心圆和角度测量工具的帮助下，对双侧Severin III髋关节患者的外侧中心边缘角CEA进行测量。

TABLE 1. Severin Algorithm

表1. Severin算法

TABLE 2. Interobserver and Intraobserver Reliability Measures for CEAs and Severin Ratings

表 2. 外侧中心边缘角CEA和Severin评级的观察者之间和观察者内可靠性检测

TABLE 3. Intraobserver Reliability for Center Edge Angles

表3.外侧中心边缘角CEA的观察者内可靠性

TABLE 4. Interobserver Reliability for Center Edge Angles

表4.外侧中心边缘角CEA的观察者之间可靠性

TABLE 5. Intraobserver Reliability for Severin and Clinically Relevant Groups

表5. Severin和临床相关分组的观察者内可靠性

TABLE 6. Interobserver Reliability for Severin Grades

表6. Severin等级的观察者之间可靠性

Measurement of the center edge angle and determination of the Severin classification using digital radiography, computer-assisted measurement tools, and a Severin algorithm: intraobserver and interobserver reliability revisited

Abstract

Background: Numerous studies underscore the poor intraobserver and interobserver reliability of both the center edge angle (CEA) and the Severin classification using plain film measurements. In this study, experienced observers applied a computer-assisted measurement program to determine the CEA in digital pelvic radiographs of adults who had been previously treated for dysplasia of the hip (DDH). Using a teaching aid/algorithm of the Severin classification, the observers then assigned a Severin rating to these hips. Intraobserver and interobserver errors were then calculated on both the CEA measurements and the Severin classifications.

Methods: Four pediatric orthopaedic surgeons and 1 pediatric radiologist calculated the CEAs using the OrthoView TM planning system and then determined the Severin classification on 41 blinded digital pelvic radiographs. The radiographs were evaluated by each examiner twice, with evaluations separated by 2 months. All examiners reviewed a Severin classification algorithm before making their Severin assignments. The intraobserver and interobserver reliability for both the CEA and the Severin classification were calculated using the interclass correlation coefficients and Cohen and Fleiss κ scores, respectively.

Results: The intraobserver and interobserver reliability for CEA measurement was moderate to almost perfect. When we separated the Severin classification into 3 clinically relevant groups of good (Severin I and II), dysplastic (Severin III), and poor (Severin IV and above), our interobserver reliability neared almost perfect.

Conclusion: The Severin classification is an extremely useful and oft-used radiographic measure for the success of DDH treatment. Our research found digital radiography, computer-aided measurement tools, the use of a Severin algorithm, and separating the Severin classification into 3 clinically relevant groups significantly increased the intraobserver and interobserver reliability of both the CEA and Severin classification. This finding will assist future studies using the CEA and Severin classification in the radiographic assessment of DDH treatment outcomes.

文献出处：Kristen L Carroll, Kathleen A Murray, Lynne M MacLeod, Theresa A Hennessey, Marcella R Woiczik, James W Roach. Measurement of the center edge angle and determination of the Severin classification using digital radiography, computer-assisted measurement tools, and a Severin algorithm: intraobserver and interobserver reliability revisited. J Pediatr Orthop. 2011 Jun;31(4):e30-5.doi?10.1097/BPO.0b013e31821adde9.