EOS 3D测量青少年特发性脊柱侧凸患者冠、矢状面参数的可信度及可重复性

Reliability and reproducibility of EOS 3D measurements in adolescent idiopathic scoliosis

背景:EOS全身影像系统在骨科疾病尤其是脊柱畸形的诊治中得到广泛应用,但仍未取代常规放射技术。目的:与常规2D测量对比,探讨EOS 3D测量青少年特发性脊柱侧凸(AIS)患者冠、矢状面参数的可信度及可重复性。方法:回顾性分析于2018年1月至2019年1月间收治的30例AIS患者的影像学资料。两位医师同时进行常规2D和EOS3D测量,1周后分别重复测量1次。记录每次测量所需要的时间和相关参数,并进行比较。采用一致性检验研究测量数据的可信度和可重复性,计算组内相关系数与组间相关系数。结果:每例患者常规2D测量平均时间为(7±3)min,EOS 3D测量平均时间为(22±7)min。无论是常规2D测量,还是EOS 3D测量,同一测量者两次测量结果差异均无统计学意义。常规2D测量时,不同测量者间测量的L1~5腰前凸、PT差异有统计学意义(t=4.98,P=0.015;t=4.01,P=0.002),而其余指标差异无统计学意义;EOS 3D测量时,不同测量者间测量数据差异均无统计学意义。EOS 3D测量Cobb角的组内及组间测量误差均小于常规2D测量,且差异均有统计学意义(t=5.03,P<0.001;t=2.61,P=0.014;t=9.23,P=0.013)。对于常规2D测量,测量者1组内一致性为中等至好,测量者2组内一致性好,组间一致性为中等。对于EOS3D测量,测量者1组内一致性为好至极佳,测量者2组内一致性极佳,组间一致性为极佳。常规2D与EOS 3D测量结果组间一致性好。结论:在AIS患者冠、矢状面参数测量中,常规2D测量可信度及可重复性较低。EOS 3D测量具有较高的可信度和可重复性,但需专业技术人员培训,且测量时间成本较高。两者各有利弊,医师可以根据患者的病情需要以及医院的硬件设施条件选择合适的成像方法。

Background: Despite of its wide application, EOS imaging could not take the place of routine X-rays. Objective:To explore the reliability and reproducibility of EOS 3D measurements in adolescent idiopathic scoliosis(AIS). Methods: Imaging data of 30 AIS patients admitted to our institution from January 2018 to January 2019 were reviewed. Two physicians performed routine 2 D and EOS 3D measurements twice with an interval of one week, respectively. The time spent on each measurement and corresponding parameters were recorded. The inter-observer reliability and intra-observer repeatability of the two methods were analyzed by Inter/intra-class Correlation Coefficient. Results: The mean time was(7±3) min for routine 2 D measurement and(22±7) min for EOS 3D measurement. There was no significant difference between two sets of data from the same physician either in routine 2 D or EOS 3D measurements. In 2 D measurement, there were statistic differences in the lordosis and PT of L1-L5 between the two physicians(t=4.98, P=0.015;t=4.01, P=0.002). There was no significant difference in the parameters of EOS 3D measurement between the two physicians. The measuring errors of Cobb angle in EOS 3D measurement were significantly smaller than those in 2 D measurement(t=5.03, P<0.001;t=2.61, P=0.014;t=9.23, P=0.013). In 2 D measurement, intra-class correlation coefficient was 0.60-0.75(moderate to good) in physician 1 and 0.70-0.90(good) in physician 2;inter-class correlation coefficient was 0.50-0.70(moderate). In EOS 3D measurement, intra-class correlation coefficient was 0.85-1.00(good to excellent) in physician 1 and 0.90-1.00(excellent) in another;inter-class correlation coefficient was 0.90-1.00(excellent). The inter-class correlation coefficient between 2 D and 3D measurements was 0.70-0.9(good). Conclusions: The reliability and reproducibility of routine 2 D measurements in AIS patients are relatively low. EOS 3D measurements show better reliability and reproducibility with lower measurement errors, but it is time-costing and needs special training. Surgeons can make their own choice according to conditions of patients and institutions.