足拇外翻远端截骨术后HAV角和IM角不同X线片测量方法的Bland-Altman分析  

Bland-Altman analysis of different X-ray measurements of HAV angle and IM angle after hallux valgus distal osteotomy

作　　者：吴寿长[1] 胡海威[1] 温建民[1] 孙卫东 张立颖[1] 孙世栋[1] 张鹤礼 范为之[1] 程远俊 

机构地区：[1]中国中医科学院望京医院关节科,北京100102

出　　处：《中国骨与关节损伤杂志》2015年第6期610-613,共4页Chinese Journal of Bone and Joint Injury

基　　金：首都临床特色应用研究(Z131107002213057)

摘　　要：目的确定足拇外翻远端截骨术后适宜的HAV角和IM角X线测量方法。方法采用影像学测量软件对足拇外翻术后X线片进行测量,不同测量者使用6种方法测量同一张X线片;同一测量者使用6种方法测量不同X线片,对测量结果进行Bland-Altman分析和一致性评价。结果不同测量者使用6种方法对同一张片子测量,测量值之间的差异无统计学意义(P>0.05)。同一测量者使用6种方法测量不同X线片,方法 C测量平均值最小,标准差和置信区间的范围最窄,其次是方法 A和D;方法 B测量值的标准差及置信区间比其他方法大。方法 A与方法 D的差值的标准差最小,在可信区间内最接近,二者具有较高的一致性。结论方法 A利用测量软件自动确定第1跖骨轴线,重复性好,测量可靠、准确,可作为足拇外翻术后X线软件测量的"金标准"。方法 D在手工测量时第1跖骨轴线参考点唯一、重复性好、最为准确,可作为足拇外翻远端截骨术后X线片的首选测量方法。Objective To determine the appropriate method of hallux abductor valgus angle（HAV angle） and the first intermetatarsal angle（IM angle） X-ray measurement on the distal osteotomy of hallux valgus. Methods X-ray films of postoperative hallux valgus were measured by professional imaging measurement software. Six kinds of measurement methods were used by different measurers to measure the same X-ray film. Six kinds of measurement methods were used by the same measurer to measure different X-ray films. Bland-Altman analysis and consistency evaluation were conducted for the measurement results. Results The difference between measurement values which were measured by different measurers were compared using 6 kinds of measurement methods（P〉0.05）. There was no statistically significant difference. The average measurement of method C was minimum value. The standard deviation and the confidence interval range was the narrowest. In the second place was method A and D. The standard deviation of measurement value and the confidence interval of method B were larger than the other methods. Method A and D were the closest within the confidence interval, both had the high consistency. Conclusion Method A using measurement software to automatically determine the first metatarsal axis is reliable, accurate, well reproducible, and could be used as the ＂gold standard＂ of software measurement to postoperative hallux valgus X-ray. Method D determined the first metatarsal axis is the most accurate, reproducible, and has only one reference point when it comes to manual measurement. So it could be used as the first choice of X-ray measurement of distal osteotomy of hallux valgus.

关 键 词：足拇外翻 X线片 测量 Bland-Altman分析 

分 类 号：R687.31[医药卫生—骨科学]