te Stroet Martijn A J, Holla Micha, Biert Jan, van Kampen Albert
Radboud University Nijmegen Medical Centre, Postbox 9101, 6501 HB, Nijmegen, The Netherlands.
Emerg Radiol. 2011 Aug;18(4):279-83. doi: 10.1007/s10140-010-0932-5. Epub 2011 Mar 11.
This study aimed to evaluate the intra- and interobserver agreement for both fracture classification according to Schatzker and treatment plan of tibial plateau fractures using plain radiographs alone and with computed tomography (CT) scans. The study was carried out prospectively to assess the impact of an advanced radiographic study on the agreement of treatment plan and fracture classification of tibial plateau fractures. Eight experienced observers (six surgeons and two radiologists) classified 15 tibial plateau fractures with plain radiographs and CT scans and set up a treatment plan. Agreement was measured using kappa coefficients. Using plain radiographs alone, the mean interobserver kappa coefficient for classification was 0.47, which decreased to 0.46 after addition of CT scans. Using plain films alone for formulating a treatment plan, the mean interobserver kappa coefficient was 0.40, which decreased to 0.30 after addition of CT scans. The mean intraobserver kappa coefficient for fracture classification using plain radiographs was 0.60, which decreased to 0.57 with addition of CT scans. The mean intraobserver kappa coefficient for treatment plan based on plain radiographs alone was 0.53, which decreased to 0.45 after addition of CT scans. In contrast with other recent publications, there is no increase in inter- and intra-agreement of a CT scan compared to plain radiographs for the classification and treatment plan in tibial plateau fractures. Routine CT scanning of the knee for tibial plateau fractures is not supported by this study.
本研究旨在评估仅使用X线平片以及联合计算机断层扫描（CT）对胫骨平台骨折进行Schatzker骨折分类及制定治疗方案时的观察者内和观察者间一致性。本研究为前瞻性研究，旨在评估一项先进的影像学检查对胫骨平台骨折治疗方案一致性及骨折分类的影响。八位经验丰富的观察者（六位外科医生和两位放射科医生）通过X线平片和CT扫描对15例胫骨平台骨折进行分类，并制定治疗方案。采用kappa系数来衡量一致性。仅使用X线平片时，分类的观察者间平均kappa系数为0.47，添加CT扫描后降至0.46。仅使用平片制定治疗方案时，观察者间平均kappa系数为0.40，添加CT扫描后降至0.30。使用X线平片进行骨折分类的观察者内平均kappa系数为0.60，添加CT扫描后降至0.57。仅基于X线平片的治疗方案的观察者内平均kappa系数为0.53，添加CT扫描后降至0.45。与其他近期发表的研究不同，对于胫骨平台骨折的分类和治疗方案，与X线平片相比，CT扫描的观察者间和观察者内一致性并未提高。本研究不支持对胫骨平台骨折常规进行膝关节CT扫描。
