全脊柱成像系统与传统X线在腰椎-骨盆矢状面参数的一致性对比

Consistency comparison of the parameters of the lumbar spine-pelvic sagittal plane between the whole-spine EOS images system and traditional X-ray

目的:探讨腰椎-骨盆矢状面参数在全脊柱EOS成像系统(whole-spine EOS images,EOS)与传统X线成像的一致性。方法:选择2019年5月至7月在北京积水潭医院脊柱外科住院的患者50例(男26例,女24例),进行标准站立位EOS脊柱全长正侧位和传统X线腰椎骨盆正侧位摄片。2名主治医师分别使用Surgimap软件对50例患者EOS侧位片和传统X线腰椎骨盆侧位片的骨盆入射角(pelvic incidence,PI),骨盆倾斜角(pelvic tilt,PT),骶骨倾斜角(sacral slope,SS),腰椎前凸角(lumbar lodorsis,LL)进行测量,并于间隔2周后在再次测量。对2名医师测量的结果进行一致性检验(可信度分析),对2名医师前后2次测量结果进行一致性检验(可重复性分析)。利用4次测量数据分析腰椎-骨盆矢状面平衡参数在EOS与传统X线的一致性和差异性。结果:使用EOS成像和传统X线成像测量的PI角均值分别为(50.5±12.6)°和(51.4±12.2)°(均值差0.9,差值95%置信区间为0.2-1.6,P=0.020);PT角均值分别为(16.2±8.9)°和(16.9±8.6)°(均值差0.7,差值95%置信区间为-0.6-2.0,P=0.283);SS角均值分别为(34.3±9.9)°和(34.5±10.4)°(均值差0.2,差值95%置信区间为-1.2-1.5,P=0.800);LL角均值分别为(42.7±14.9)°和(43.3±15.3)°(均值差0.6,差值95%置信区间为-0.8-2.0,P=0.149)。两种不同成像方法测量骨盆PI差异有统计学意义(P=0.020,P<0.05),但均差值小(0.9°),无临床差异性;PT、SS、LL差异无统计学意义(P>0.05)。两种成像方法组间可信度分析显示,2名医师使用Surgimap软件测量侧位PI、PT、SS、LL均有极佳的一致性(EOS成像的相关系数分别为0.984、0.993、0.980、0.989,X线成像的相关系数分别为0.975、0.985、0.976、0.988)。可重复性分析显示,2名主治医师前后2次测量的PI、PT、SS、LL均有极佳的一致性(组内ICC为0.963~0.996)。结论:在局部腰椎骨盆段,EOS成像与传统X线成像测量的PI、PT、SS、LL一致性良好,对指导临床的应用没有差异性。

Objective:To explore the consistency of the parameters of the lumbar spine-pelvic sagittal plane between the whole-spine EOS images(EOS)and traditional X-ray imaging.Methods:A total of 50 patients(26 males and 24 females)hospitalized in the Spine Surgery Department of Beijing Jishuitan Hospital from May to July 2019 were selected for standard standing EOS full-length spine anterolateral and traditional X-ray lumbar pelvic anterior and lateral X-rays.Two attending physicians used Surgimap software to measure the pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),lumbar lordosis(LL)of the two types of images and repeated these process after two weeks.The consistency test(reliability analysis)was performed on the results measured by two physicians,and the results measured at the two time points were tested for intra-observer consistency(repeatability analysis).The data were combined to perform consistency and difference tests for the parameters between two types of images finally.Results:The mean values of PI measured by EOS imaging and traditional X-ray imaging were(50.5±12.6)°and(51.4±12.2)°,mean difference 0.9,95%credible interval(0.2-1.6),P=0.020;the mean values of PT were(16.2±8.9)°and(16.9±8.6)°,mean difference 0.7,95%credible interval(-0.6-2.0),P=0.283;the mean values of SS were(34.3±9.9)°and(34.5±10.4)°,mean difference 0.2,95%credible interval(-1.2-1.5),P=0.800;the mean values of LL were(42.7±14.9)°and(43.3±15.3)°,mean difference 0.6,95%confidence interval(-0.8-2.0),P=0.149.The difference in PI between the two imaging methods was statistically significant(P=0.020,P<0.05),but the average difference was small(0.9°),there was no clinical difference.There were no significant differences in PT,SS and LL between the two imaging methods(P>0.05).Inter-group reliability analysis showed excellent agreement between the two physicians in measuring lateral PI,PT,SS and LL using Surgimap software(correlation coefficients within EOS imaging were 0.984,0.993,0.980,0.989;correlation coefficients within X-ray imaging were 0.975,0.985,0.976,0.988).Repeatability analysis showed that PI,PT,SS and LL measured by the two attending physicians at two time points had excellent consistency(ICC within the group was 0.963-0.996).Conclusion:In the local lumbar pelvis segment,the PI,PT SS and LL measured by EOS imaging and traditional X-ray imaging had good agreement,and there was no difference in guiding clinical application.