Humphrey Catherine A, Dirschl Douglas R, Ellis Thomas J
Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA.
J Orthop Trauma. 2005 Oct;19(9):616-22. doi: 10.1097/01.bot.0000177107.30837.61.
This study was designed to determine whether the interobserver reliability of a fracture classification scheme applied based on a single, carefully defined, computed tomography (CT) cut is greater than those previously reported for systems designed for use with plain radiographs.
Observer review of selected cases.
Four, level one, trauma centers.
Pretreatment CT scans of patients with calcaneus fractures were screened by the authors. Thirty cases were selected that had an appropriate semicoronal CT image. Ten orthopaedic traumatologists who were members of the Orthopaedic Trauma Association and had a minimum of 5 years postresidency experience were selected as reviewers.
The reviewers were provided with a digital CT image for each case as well as written and diagrammatic representations of the Sanders classification system. The observers then classified each fracture according to the Sanders classification.
: The mean kappa value for interobserver reliability for fracture types I-IV was 0.41 +/- 0.02 (mean +/- standard error of the mean; range, 0.07-0.64). Observers disagreed by more than 1 fracture type (ie, I vs. III or II vs. IV) in 10% of the cases. Observers agreed on the location of the fracture lines (A, B, C) in 90% of type II fractures and 52% of type III fractures.
The results indicate that in a carefully controlled paradigm, the interobserver reliability with a classification system based on interpretation of a single, carefully defined CT image was no better than the results reported for the same classification system used with full CT data or for other classification systems used for various fractures in the skeleton. Agreement in identifying the location of the fracture lines was very good for simple fractures but much worse for complex injuries. Additional study may determine whether the use of a full complement of CT images can improve reliability in classification of complex injuries.
本研究旨在确定基于单一、精确定义的计算机断层扫描（CT）切片应用的骨折分类方案的观察者间可靠性是否高于先前报道的用于普通X线片的系统。
对选定病例进行观察者评估。
四家一级创伤中心。
作者筛选了跟骨骨折患者的治疗前CT扫描。选择了30例具有合适半冠状面CT图像的病例。10名骨科创伤协会成员且至少有5年住院后经验的骨科创伤科医生被选为评估者。
为每位评估者提供每个病例的数字CT图像以及桑德斯分类系统的书面和图表说明。然后，评估者根据桑德斯分类对每个骨折进行分类。
骨折类型I-IV的观察者间可靠性的平均kappa值为0.41±0.02（平均值±平均值的标准误差；范围为0.07-0.64）。在10%的病例中，观察者对骨折类型的分歧超过1种（即I与III或II与IV）。在90%的II型骨折和52%的III型骨折中，观察者对骨折线位置（A、B、C）达成了一致。
结果表明，在精心控制的范式中，基于对单一、精确定义的CT图像解释的分类系统的观察者间可靠性并不优于使用完整CT数据的相同分类系统或用于骨骼各种骨折的其他分类系统所报告的结果。对于简单骨折，在确定骨折线位置方面的一致性非常好，但对于复杂损伤则要差得多。进一步的研究可能会确定使用完整的CT图像是否可以提高复杂损伤分类的可靠性。
