Orthopaedic Department, General Hospital of Nikea, 15452, Athens, Piraeus, Greece.
Injury. 2009 Oct;40(10):1098-103. doi: 10.1016/j.injury.2009.06.005. Epub 2009 Jul 3.
The aim of this study was to improve the reliability of Letournel classification system using a guideline algorithm protocol. The study was conducted upon two groups of orthopaedic surgeons with different experience and was consisted of two observation sessions (A and B). In session A, every observer studied, with no instructions or guidelines, a particular set of acetabular fractures on AP and Judet oblique views. In session B the observers had to examine the same set of radiographs by taking into account a guideline algorithm protocol. The unweighted kappa coefficient was utilised to estimate the observers' agreement arising from the examination of the given X-rays. Finally, the agreement of the observers, related to the intraoperative diagnosis was estimated. The main finding of the herein study lies on the improvement of the agreement rate experienced within both groups, in session B over session A. It is reasonable to assume that the main reason behind this result is the provision of the guideline algorithm protocol in the second session. The total agreement rate was increased from 59.9% in session A to 72.1% in session B, (p value=0.0267). Our findings confirm the reliability of Letournel classification system and the proposed guideline algorithm protocol further improve the ability to classify the most complex acetabular fractures types.
本研究旨在通过指南算法协议提高 Letournel 分类系统的可靠性。该研究由两组经验不同的骨科医生进行，包括两个观察阶段（A 和 B）。在阶段 A 中，每位观察者在没有任何指导或准则的情况下，对特定的一组髋臼骨折的前后位和 Judet 斜位 X 光片进行研究。在阶段 B 中，观察者必须根据指南算法协议检查同一组 X 光片。未加权 kappa 系数用于评估观察者在检查给定 X 光片时产生的一致性。最后，评估了观察者与术中诊断的一致性。本研究的主要发现是，两组观察者在第二阶段（B 阶段）的一致性率都有所提高。这一结果的主要原因是第二阶段提供了指南算法协议，这是合理的假设。总体一致性率从阶段 A 的 59.9%提高到阶段 B 的 72.1%（p 值=0.0267）。我们的研究结果证实了 Letournel 分类系统的可靠性，并且所提出的指南算法协议进一步提高了对最复杂髋臼骨折类型进行分类的能力。
