Oakes Daniel A, Jackson Kent R, Davies Mark R, Ehrhart Kevin M, Zohman Gary L, Koval Kenneth J, Lieberman Jay R
Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
Clin Orthop Relat Res. 2003 Apr(409):232-40. doi: 10.1097/01.blo.0000059583.08469.e5.
The current study evaluates the interobserver reliability and intraobserver reproducibility of the Garden classification of femoral neck fractures, assesses the influence of a lateral radiograph on a fracture's classification, and determines the classification's impact on the surgeon's choice of operative treatment. Forty radiographs of femoral neck fractures were evaluated independently by five orthopaedic surgeons. Kappa values were calculated for interobserver reliability and intraobserver variability with respect to the readers' ability to assess the fractures using the Garden classification and to determine fracture displacement with and without access to a lateral radiograph. In 69% of the instances in which a reader changed the classification of a fracture, the proposed treatment of the fracture did not change. The Garden classification has poor interobserver reliability but good intraobserver reproducibility. The addition of a lateral radiograph does not seem to improve the reliability of the current Garden classification system but may improve the reader's ability to determine fracture displacement. To improve the reliability and usefulness of the Garden classification, the authors suggest that the classification should be modified to have only two stages (Garden A-nondisplaced or valgus impacted and Garden B-displaced) and to include the use of a lateral radiograph.
本研究评估了股骨颈骨折Garden分型的观察者间可靠性和观察者内可重复性，评估了侧位X线片对骨折分型的影响，并确定了该分型对外科医生手术治疗选择的影响。5名骨科医生独立评估了40张股骨颈骨折的X线片。计算了观察者间可靠性和观察者内变异性的Kappa值，以评估读者使用Garden分型评估骨折以及在有和没有侧位X线片的情况下确定骨折移位的能力。在读者改变骨折分型的69%的病例中，骨折的建议治疗方案并未改变。Garden分型的观察者间可靠性较差，但观察者内可重复性良好。增加侧位X线片似乎并不能提高当前Garden分型系统的可靠性，但可能会提高读者确定骨折移位的能力。为了提高Garden分型的可靠性和实用性，作者建议将该分型修改为仅分为两个阶段（Garden A型-无移位或外翻嵌插型和Garden B型-移位型），并纳入侧位X线片的使用。
