Department of Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland.
Foot Ankle Int. 2012 Sep;33(9):727-33. doi: 10.3113/FAI.2012.0727.
This study evaluated the impact of three-dimensional (3D) volume-rendering computed tomography (CT) reconstructions on the inter- and intraobserver reliability of six commonly used classification systems in the assessment of calcaneal fractures.
Four independent observers with different levels of clinical training evaluated 64 fractures according to the classifications of the Orthopaedic Trauma Association (OTA), Essex-Lopresti, Sanders, Crosby, Zwipp, and Regazzoni, using two-dimensional (2D) CT scans with multiplanar reconstructions and 3D volume-rendering reconstructions.
Interobserver reliability was moderate for the OTA, Essex-Lopresti, Sanders, Crosby, and Regazzoni classifications with 2D CT scans and 3D CT reconstructions. The Zwipp classification was poor with 2D CT scans and improved to moderate with 3D reconstructions. Intraobserver reliability with 2D CT scans was good for the Essex-Lopresti classification and moderate for the OTA, Sanders, Crosby, Zwipp, and Regazzoni classifications. After the addition of 3D reconstructions, all classifications showed moderate intraobserver reliability.
According to the findings of this study, the additional use of 3D reconstructions is of minor value when used in conjunction with the classifications of the OTA, Sanders, Crosby, Regazzoni, and Essex-Lopresti. If calcaneal fractures are assessed with the Zwipp classification, 3D reconstructions could be used to achieve comparable reproducibility compared to other classifications.
3D reconstructions may have other benefits not evaluated in the presented study and may give useful information not captured by current classification systems.
本研究评估了三维（3D）容积再现 CT（CT）重建对六种常用分类系统评估跟骨骨折的观察者间和观察者内可靠性的影响。
4 名具有不同临床培训水平的独立观察者根据 Orthopaedic Trauma Association（OTA）、Essex-Lopresti、Sanders、Crosby、Zwipp 和 Regazzoni 分类，使用二维（2D）CT 扫描和多平面重建以及 3D 容积再现重建评估 64 例骨折。
使用 2D CT 扫描和 3D CT 重建时，OTA、Essex-Lopresti、Sanders、Crosby 和 Regazzoni 分类的观察者间可靠性为中度。使用 2D CT 扫描时，Zwipp 分类较差，使用 3D 重建时则为中度。使用 2D CT 扫描时，Essex-Lopresti 分类的观察者内可靠性良好，OTA、Sanders、Crosby、Zwipp 和 Regazzoni 分类的观察者内可靠性为中度。在添加 3D 重建后，所有分类均显示出中度的观察者内可靠性。
根据本研究的结果，当与 OTA、Sanders、Crosby、Regazzoni 和 Essex-Lopresti 分类联合使用时，额外使用 3D 重建的价值不大。如果使用 Zwipp 分类评估跟骨骨折，则可以使用 3D 重建来获得与其他分类相当的可重复性。
3D 重建可能具有本研究未评估的其他益处，并可能提供当前分类系统无法捕捉的有用信息。
