Blauth M, Bastian L, Knop C, Lange U, Tusch G
Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
Orthopade. 1999 Aug;28(8):662-81. doi: 10.1007/s001320050397.
The purpose of a fracture classification is to help the surgeon to choose an appropriate method of treatment for each and every fracture occurring in a particular anatomical region. The classification tool should not only suggest a method of treatment, it should also provide the surgeon with a reasonably precise estimation of the outcome of that treatment. But to use a classification before its workability has been proved is inappropriate and can lead to confusion and more conflicting results. Any classification system should be proved to be a workable tool before it is used in a discriminatory or predictive manner. The radiographs of fourteen fractures of the lumbar spine were used to assess the interobserver reliability of the AO classification system. The radiographs and CT scans were reviewed in twenty-two hospitals experienced with spinal trauma. The mean interobserver agreement for all fourteen cases was found to be 67% (41-91%), when only the three main types (A, B, C) were used. The corresponding kappa value of the interobserver reliability showed a coefficient of 0.33 (range, 0.30 to 0.35). The reliability decreased by increasing the categories. For some injuries the interobserver reliability was found to be over 90% and also for the recommended therapeutic procedure there was an acceptable agreement. But the decision between an posterior approach alone or an additionally anterior procedure seems to be the most important question in treatment of spinal injuries at that time.
骨折分类的目的是帮助外科医生为特定解剖区域发生的每一例骨折选择合适的治疗方法。分类工具不仅应建议一种治疗方法，还应向外科医生提供该治疗结果的合理精确估计。但在其可行性得到证明之前就使用分类是不合适的，可能会导致混淆和更多相互矛盾的结果。任何分类系统在以区分或预测方式使用之前，都应被证明是一种可行的工具。使用腰椎的14例骨折的X线片来评估AO分类系统的观察者间可靠性。在22家有脊柱创伤经验的医院对X线片和CT扫描进行了复查。当仅使用三种主要类型（A、B、C）时，发现所有14例病例的观察者间平均一致性为67%（41%-91%）。观察者间可靠性的相应kappa值显示系数为0.33（范围为0.30至0.35）。随着分类的增加，可靠性降低。对于某些损伤，观察者间可靠性超过90%，并且对于推荐的治疗程序也有可接受的一致性。但当时，单纯后路手术还是额外加做前路手术之间的抉择似乎是脊柱损伤治疗中最重要的问题。
