Department of Trauma and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
Arch Orthop Trauma Surg. 2011 Oct;131(10):1397-403. doi: 10.1007/s00402-011-1312-7. Epub 2011 May 5.
CT scans are deemed to be the gold standard for the evaluation of calcaneal fractures. However, the reliability of the interpretation has not been studied systematically.
In a prospective multicenter study, the CT data set of five different fractures was presented to 57 evaluators. The participating surgeons were asked to assess calcaneal fractures on the basis of a multiple choice questionnaire. The CT scans were validated by the intraoperative findings. The questionnaires were compared to the model solution of three foot and ankle surgeons. The intra- and interrater reliability was calculated.
The proportion of intraobserver agreement was 82%. Cohen's kappa was κ = 0.748 with P < 0.0001. In total, 61% of the items were answered similarly to the model answer. Only 27% of the evaluators were able to correctly classify the fracture according to Sanders and 63% of the evaluators agreed that surgical procedure was necessary. The more experienced the surgeon, the higher was the interrater agreement.
This is the first study to systematically analyze the reliability of the interpretation of CT scans of calcaneal fractures. This was found to be unsatisfactory. Future studies must show, if specific interventions, e.g., teaching programs or image procession modalities (e.g., 3D reconstructions), are capable of improving the quality of interpretation of CT scans for calcaneal fractures.
CT 扫描被认为是评估跟骨骨折的金标准。然而，其解读的可靠性尚未得到系统研究。
在一项前瞻性多中心研究中，将 5 种不同骨折的 CT 数据集呈现给 57 名评估者。要求参与的外科医生根据多项选择题问卷评估跟骨骨折。通过术中发现对 CT 扫描进行验证。将问卷与 3 名足踝外科医生的模型解答进行比较。计算了组内和组间的可靠性。
观察者内一致性的比例为 82%。Cohen 的 κ 值为 0.748（P<0.0001）。总体而言，61%的项目与模型答案相似。只有 27%的评估者能够根据 Sanders 正确分类骨折，而 63%的评估者同意需要手术。外科医生经验越丰富，组间一致性越高。
这是第一项系统分析 CT 扫描解读跟骨骨折可靠性的研究。结果并不理想。未来的研究必须表明，是否可以通过特定的干预措施，例如教学计划或图像处理方式（例如 3D 重建）来提高 CT 扫描对跟骨骨折的解读质量。
