股骨干骨折患儿骨折成角的X线测量可靠性
Reliability of radiographic measurement of fracture angulation in children with femoral shaft fractures.
作者信息
Owen Janice L, Stephens Derek, Wright James G
机构信息
Child Health Evaluative Sciences and the Department of Surgery, The Hospital for Sick Children, Toronto, Ont., Canada.
出版信息
Can J Surg. 2007 Apr;50(2):115-8.
INTRODUCTION
Clinical decisions are based on x-ray measures of radiographs. However, the reliability of assessing the angular measurement of fractured femurs in children is unknown. The purpose of this study was to determine the intra- and interrater reliability of an x-ray assessment of femoral shaft fracture angulation in children.
METHODS
On 2 occasions, 3 raters evaluated 30 radiographs of children aged 4 to 10 years, 3 to 24 months after a femoral fracture. The radiographs were evaluated by an orthopedic surgeon, an orthopedic fellow and a research assistant, using a standardized methodology. Reliability was assessed with the intraclass correlation coefficient (ICC), an index of concordance that ranges from 01, where > 0.75 indicates excellent concordance.
RESULTS
The ICC for the intrarater ranged from 0.75 to 0.97. The interrater reliability ICC for anterior or posterior angulation was 0.91 (95% confidence interval [CI] 0.840.95) and for varus or valgus angulation was 0.90 (95% CI 0.790.95). A change in measurement of more than 5 degrees exceeds the variation in measurement and, therefore, can be attributed to a true shift in fracture position.
CONCLUSIONS
With specific standardized protocols, radiographic assessment of femoral fractures is reliable, irrespective of the examiner's level of experience.
引言
临床决策基于X线片的测量结果。然而，评估儿童股骨骨折角度测量的可靠性尚不清楚。本研究的目的是确定儿童股骨干骨折成角的X线评估在同一评估者及不同评估者之间的可靠性。
方法
在股骨骨折后3至24个月，3名评估者分两次对30例4至10岁儿童的X线片进行评估。这些X线片由一名骨科医生、一名骨科住院医师和一名研究助理采用标准化方法进行评估。使用组内相关系数（ICC）评估可靠性，ICC是一种一致性指标，范围从0到1，其中>0.75表示高度一致。
结果
同一评估者的ICC范围为0.75至0.97。前后成角的不同评估者间可靠性ICC为0.91（95%置信区间[CI]0.84至0.95），内翻或外翻成角的ICC为0.90（95%CI0.79至0.95）。测量变化超过5度超出了测量的变异范围，因此可归因于骨折位置的真正改变。
结论
采用特定的标准化方案，无论检查者的经验水平如何，股骨骨折的X线评估都是可靠的。
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