基于计算机断层扫描的胫骨平台骨折三柱分类:介绍其应用及评估其可重复性。
Computed tomography-based Three-Column Classification in tibial plateau fractures: introduction of its utility and assessment of its reproducibility.
机构信息
Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China.
出版信息
J Trauma Acute Care Surg. 2012 Sep;73(3):731-7. doi: 10.1097/TA.0b013e31825c17e7.
BACKGROUND
The purpose of our study is to introduce a new Three-Column Classification for tibial plateau fractures and evaluate its reproducibility and reliability.
METHODS
From December 2004 to December 2006, 278 consecutive patients with tibial plateau fractures were treated operatively at the Department of Orthopedics and Trauma III in Shanghai Sixth People's Hospital. Computed tomography (CT) and three-dimensional reconstruction were preformed for each patient before open reduction and internal fixation. The approaches were instructed by the Three-Column Classification. To test the reproducibility of the Three-Column Classification, the interobserver and intraobserver reliability of this classification system compared with that of the Schatzker Classification was investigated by four observers.
RESULTS
Fourteen cases could not be classified by Schatzker Classification. Meanwhile, all cases could be classified by the Three-Column Classification. Using plain radiographs, the mean κ values for interobserver reliability using Schatzker Classification systems were 0.567 (range, 0.513-0.589), representing "moderate agreement," whereas the mean κ values were 0.766 (range, 0.706-0.890), representing "substantial agreement" by the use of the Three-Column Classification based on the CT scan. The mean κ values for intraobserver reliability using Schatzker Classification and the Three-Column Classification based on the CT scan were 0.758 (range, 0.691-0.854) and 0.810 (range, 0.745-0.918), respectively, representing "substantial agreement."
CONCLUSION
The Three-Column Classification demonstrates a higher interobserver reliability and can be used as a supplement to the conventional Schatzker Classification, especially in the complex and posterior comminuted tibial plateau fractures. Furthermore, the Three-Column Classification is clinically relevant and, to some degree, can instruct the surgeon in preoperative planning.
LEVEL OF EVIDENCE
Diagnostic study, level III.
背景
本研究的目的是介绍一种新的胫骨平台骨折三柱分类方法，并评估其可重复性和可靠性。
方法
2004 年 12 月至 2006 年 12 月，上海第六人民医院骨科创伤三科对 278 例胫骨平台骨折患者进行了手术治疗。每位患者在切开复位内固定前均进行了计算机断层扫描（CT）和三维重建。根据三柱分类方法选择入路。为了测试三柱分类的可重复性，通过 4 位观察者比较了该分类系统与 Schatzker 分类的观察者间和观察者内可靠性。
结果
14 例无法用 Schatzker 分类法分类。同时，所有病例均可用三柱分类法分类。使用普通 X 线片，Schatzker 分类系统观察者间可靠性的平均κ值为 0.567（范围为 0.513-0.589），表示“中度一致”，而使用 CT 扫描的三柱分类的平均κ值为 0.766（范围为 0.706-0.890），表示“高度一致”。Schatzker 分类和 CT 扫描下三柱分类的观察者内可靠性的平均κ值分别为 0.758（范围为 0.691-0.854）和 0.810（范围为 0.745-0.918），表示“高度一致”。
结论
三柱分类法具有较高的观察者间可靠性，可作为传统 Schatzker 分类的补充，尤其是在复杂和后柱粉碎性胫骨平台骨折中。此外，三柱分类具有临床相关性，在一定程度上可以指导术前规划。
证据水平
诊断研究，III 级。
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