Bozentka David J, Beredjiklian Pedro K, Westawski Daniel, Steinberg David R
Department of Orthopaedic Surgery, University of Pennsylvania Health Systems, Philadelphia, PA 19104, USA.
Clin Orthop Relat Res. 2002 Apr(397):409-13. doi: 10.1097/00003086-200204000-00048.
The purpose of the current study was to assess the reliability of measurement of distal radius fracture parameters using digital radiographs. Digital radiographs and corresponding plain radiographs of the wrists of 20 patients with intraarticular distal radius fractures were used to measure radial inclination, palmar tilt, radial height, and articular step-off. The plain radiographs and digital images were evaluated independently by three examiners in two sessions. The plain radiographs were assessed using a standard goniometer (manual measurements) whereas the digitized radiographs were evaluated using imaging software to do the computer-assisted measurements. The interobserver and intraobserver reliability were measured using repeated measures analysis of variance and weighted kappa statistics. Measurement of the digital images improved the interobserver reliability of measurement of palmar tilt from substantial to excellent, radial height from moderate to substantial, and articular step-off from fair to moderate. Similarly, intraobserver reliability increased from moderate to substantial when measuring radial height. In no instance (between or within observers) did the level of reliability decrease when using digital images for fracture evaluation. The current data suggest that the reliability of measurements of angular and linear fracture parameters of distal radius fractures is similar between plain and digital radiographs.
本研究的目的是评估使用数字X线片测量桡骨远端骨折参数的可靠性。对20例桡骨远端关节内骨折患者的腕部数字X线片及相应的普通X线片进行桡骨倾斜度、掌倾角、桡骨高度及关节面台阶差的测量。普通X线片和数字图像由三名检查者分两个阶段独立评估。普通X线片采用标准量角器（手动测量）进行评估，而数字化X线片则使用成像软件进行计算机辅助测量。采用重复测量方差分析和加权kappa统计量来测量观察者间和观察者内的可靠性。数字图像测量提高了观察者间测量掌倾角的可靠性，从中度提高到优秀；桡骨高度的可靠性从中度提高到高度；关节面台阶差的可靠性从一般提高到中度。同样，测量桡骨高度时，观察者内可靠性从中度提高到高度。在使用数字图像进行骨折评估时，无论是观察者间还是观察者内，可靠性水平均未降低。目前的数据表明，普通X线片和数字X线片在测量桡骨远端骨折的角度和线性骨折参数方面的可靠性相似。
