Lindenhovius Anneluuk, Karanicolas Paul Jack, Bhandari Mohit, van Dijk Niek, Ring David
Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
J Hand Surg Am. 2009 Nov;34(9):1640-6. doi: 10.1016/j.jhsa.2009.07.009. Epub 2009 Oct 14.
This study tests the hypothesis that 3-dimensional computed tomography (CT) reconstructions improve interobserver agreement on classification and treatment of coronoid fractures compared with 2-dimensional CT.
A total of 29 orthopedic surgeons evaluated 10 coronoid fractures on 2 occasions (first with radiographs and 2-dimensional CT and then with radiographs and 3-dimensional CT), separated by a minimum of 2 weeks. Surgeons classified fractures according to the classifications of Regan and Morrey and of O'Driscoll et al., identified specific characteristics, recommended the most appropriate treatment approach, and made treatment recommendations. The kappa multirater measure (kappa) was calculated to estimate agreement between observers.
Regardless of the imaging modality used, there was fair to moderate agreement for most of the observations. Three-dimensional CT improved interobserver agreement in Regan and Morrey's classsication (kappa(3-dimensional) = 0.51 vs kappa(2-dimensional) = 0.40; p < .001) and O'Driscoll et al.'s classifications (kappa(3-dimensional) = 0.48 vs kappa(2-dimensional) = 0.42; p = .009). There were trends toward better reliability for 3-dimensional reconstruction in recognition of coronoid tip fractures (kappa(3-dimensional) = 0.19, kappa(2-dimensional) = 0.03; p = .268), comminution (kappa(3-dimensional) = 0.41 vs kappa(2-dimensional) = 0.29; p = .133), and impacted fragments (kappa(3-dimensional) = 0.39 vs kappa(2-dimensional) = 0.27; p = .094), and in surgeons' opinions on the need for something other than screws or plate for surgical fixation (kappa(3-dimensional) = 0.31 vs kappa(2-dimensional) = 0.15; p = .138). Interobserver agreement on treatment approach was better with 2-dimensional CT (kappa(3-dimensional) = 0.27, kappa(2-dimensional) = 0.32; p = .015).
Three-dimensional CT reconstructions improve interobserver agreement with respect to fracture classification compared with 2-dimensional CT.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.
本研究旨在验证以下假设：与二维计算机断层扫描（CT）相比，三维CT重建可提高观察者之间在冠状突骨折分类和治疗方面的一致性。
共有29名骨科医生分两次评估10例冠状突骨折（第一次使用X线片和二维CT，第二次使用X线片和三维CT），两次评估间隔至少2周。医生们根据Regan和Morrey以及O'Driscoll等人的分类方法对骨折进行分类，识别特定特征，推荐最合适的治疗方法，并给出治疗建议。计算kappa多评分者测量值（kappa）以估计观察者之间的一致性。
无论使用何种成像方式，大多数观察结果的一致性为中等。三维CT提高了观察者之间在Regan和Morrey分类（kappa（三维）=0.51，kappa（二维）=0.40；p<0.001）以及O'Driscoll等人分类（kappa（三维）=0.48，kappa（二维）=0.42；p=0.009）方面的一致性。在识别冠状突尖骨折（kappa（三维）=0.19，kappa（二维）=0.03；p=0.268）、粉碎性骨折（kappa（三维）=0.41，kappa（二维）=0.29；p=0.133）和嵌插骨折块（kappa（三维）=0.
