原创智能手机脊柱侧弯筛查APP测量青少年特发性脊柱侧凸Cobb角的可靠性研究

The reliability of the original smartphone scoliosis screening APP for measuring the Cobb angle of adolescent idiopathic scoliosis

目的探讨使用团队原创智能手机脊柱侧弯筛查APP测量青少年特发性脊柱侧凸(AIS)Cobb角的准确性与可重复性。方法回顾性分析2020年8月至2021年2月河南省人民医院脊柱脊髓外科收治的60例AIS患儿的临床资料。3名测量者分别采用量角器、脊柱侧弯筛查APP及电脑图像存档和通信系统(PACS)3种方法对60例AIS患儿的脊柱全长正侧位X线片上的冠状位主弯Cobb角、矢状位上的胸椎后凸角(TK)、胸腰椎后凸角(TLK)及腰椎前凸角(LL)进行测量,记录每次测量的时间及结果,间隔2周后重复测量1次,采用配对t检验比较APP法与量角器法的测量时间。以PACS系统的Cobb角测量结果作为参考标准,通过配对t检验分析APP法测量Cobb角的准确性。使用组内相关系数(ICC)比较测量者内的可重复性及测量者间的一致性。结果60例AIS患儿中,男17例,女43例;年龄(12.2±2.4)岁(10~16岁);主弯为胸弯(LenkeⅠ型)23例、LenkeⅡ型18例、胸腰弯/腰弯(LenkeⅤ型)19例。APP法测量Cobb角的时间明显较量角器法短,二者比较差异有统计学意义(P<0.05)。APP法与PACS法测量的Cobb角结果比较差异无统计学意义(P>0.05)。3名测量者使用APP法测量冠状位主弯Cobb角及TK、TLK、LL的结果均有极佳的一致性(ICC分别为0.990、0.988、0.986、0.987),APP法前后2次测量冠状位主弯Cobb角及TK、TLK、LL的可重复性(ICC为0.973~0.982)均高于量角器法(ICC为0.933~0.954)。结论智能手机脊柱侧弯筛查APP较传统量角器测量AIS患儿Cobb角的时间短、效率高,准确性及可重复性高。

Objective To explore the accuracy and repeatability of the smartphone scoliosis screening APP developed by our team in the measurement of the Cobb angle of adolescent idiopathic scoliosis(AIS).Methods Clinical data of 60 patients with AIS admitted to Department of Spine and Spinal Surgery,Henan Province People′s Hospital from August 2020 to February 2021 were analyzed retrospectively.Three surveyors measured the coronal main curvature Cobb angle,sagittal thoracic kyphosis(TK)angle,thoracolumbar kyphosis(TLK)angle and lumbar kyphosis(LL)angle on whole-spine lateral X-ray films of 60 patients with AIS by means of the protractor,scoliosis screening APP and computerized Picture Archiving and Communication System(PACS).The time and results of each measurement were recorded.The measurement was repeated once after 2 weeks.Paired t-test was used to compare the measurement time of the APP method and the protractor method.Taking the Cobb angle measurement results of the PACS system as the reference standard,the accuracy of Cobb angle measurement by the APP method was analyzed by paired t-test.The repeatability of the surveyor and the consistency between the surveyors was compared by intraclass correlation coefficient(ICC).Results Among the 60 patients with AIS,there were 17 males and 43 females,aged from 10 to 16 years[(12.2±2.4)years].The main bends were thoracic curvature(LenkeⅠ)in 23 cases,LenkeⅡin 18 cases and thoracolumbar curvature/lumbar curvature(Lenke V)in 19 cases.The APP method took significantly less time to measure the Cobb angle than the protractor method(P<0.05).There was no significant difference in the Cobb angle measured by the APP method and PACS method(P>0.05).The results of the coronal main curvature Cobb angle,TK angle,TLK angle and LL angle measured by 3 surveyors through the APP method were all in good agreement(ICC=0.990,0.988,0.986,0.987).The repeatability(ICC 0.973-0.982)of the coronal main curvature Cobb angle,TK,TLK and LL measured twice before and after the APP method were both better that of the protractor method(ICC 0.933-0.954).Conclusions Compared with the traditional protractor,the smartphone scoliosis screening APP has the advantages of short measurement time,high efficiency,excellent accuracy and good repeatability in measuring the Cobb angle of AIS.