Spaans A J, van Laarhoven C M C M, Schuurman A H, van Minnen L P
Department of Plastic, Reconstructive and Hand Surgery, Universital Medical Center Utrecht, Utrecht, The Netherlands.
J Hand Surg Am. 2011 Sep;36(9):1467-70. doi: 10.1016/j.jhsa.2011.06.017. Epub 2011 Jul 29.
To determine the interobserver agreement of the Eaton-Littler classification system for radiological osteoarthritis of the first carpometacarpal (CMC1) joint and the interobserver agreement of the most appropriate treatment modality.
Forty cases of CMC1 osteoarthritis were independently presented to 5 musculoskeletal-experienced radiologists and 8 hand surgeons. These observers were asked to stage the radiographs according to Eaton and Littler's classification system (stages I-IV). The hand surgeons were also asked to choose their treatment of choice (1, conservative; 2, ligament reconstruction or extension osteotomy; 3, hemitrapeziectomy with interposition; 4, arthrodesis; 5, trapeziectomy; 6, hemiarthroplasty or total arthroplasty).
The overall mean interobserver agreement of the radiological classification was in the moderate range of agreement. The hand surgeons' mean interobserver agreement was just slightly better than the radiologists' mean. The mean interobserver agreement of treatment indicated fair strength of agreement.
The moderate interobserver agreement of the radiological classification of Eaton and Littler for staging of CMC1 osteoarthritis questions the efficiency of Eaton and Littler's classification system. The interobserver agreement in choice of treatment shows a fair agreement. These varieties in classification and in choice of treatment indicate the need for evidence-based research to define optimal classification and treatment of CMC1 osteoarthritis.
确定第一掌腕（CMC1）关节放射性骨关节炎的伊顿 - 利特勒分类系统的观察者间一致性，以及最合适治疗方式的观察者间一致性。
向5名有肌肉骨骼疾病诊断经验的放射科医生和8名手外科医生分别提供40例CMC1骨关节炎病例。要求这些观察者根据伊顿和利特勒的分类系统（I - IV期）对X光片进行分期。还要求手外科医生选择他们的首选治疗方法（1，保守治疗；2，韧带重建或延长截骨术；3，带植入物的大多角骨切除术；4，关节融合术；5，大多角骨切除术；6，半关节成形术或全关节成形术）。
放射学分类的总体观察者间一致性处于中等范围。手外科医生的观察者间平均一致性仅略优于放射科医生的平均一致性。治疗的观察者间平均一致性表明一致性强度一般。
伊顿和利特勒对CMC1骨关节炎分期的放射学分类的中等观察者间一致性对伊顿和利特勒分类系统的有效性提出了质疑。治疗选择方面的观察者间一致性显示出一般的一致性。分类和治疗选择上的这些差异表明需要进行循证研究来确定CMC1骨关节炎的最佳分类和治疗方法。
