Kamphaus A, Rapp M, Wessel L M, Buchholz M, Massalme E, Schneidmüller D, Roeder C, Kaiser M M
Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Universität zu Lübeck, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
Unfallchirurg. 2015 Apr;118(4):326-35. doi: 10.1007/s00113-013-2496-9.
There are two child-specific fracture classification systems for long bone fractures: the AO classification of pediatric long-bone fractures (PCCF) and the LiLa classification of pediatric fractures of long bones (LiLa classification). Both are still not widely established in comparison to the adult AO classification for long bone fractures.
During a period of 12 months all long bone fractures in children were documented and classified according to the LiLa classification by experts and non-experts. Intraobserver and interobserver reliability were calculated according to Cohen (kappa).
A total of 408 fractures were classified. The intraobserver reliability for location in the skeletal and bone segment showed an almost perfect agreement (K = 0.91-0.95) and also the morphology (joint/shaft fracture) (K = 0.87-0.93). Due to different judgment of the fracture displacement in the second classification round, the intraobserver reliability of the whole classification revealed moderate agreement (K = 0.53-0.58). Interobserver reliability showed moderate agreement (K = 0.55) often due to the low quality of the X-rays. Further differences occurred due to difficulties in assigning the precise transition from metaphysis to diaphysis.
The LiLa classification is suitable and in most cases user-friendly for classifying long bone fractures in children. Reliability is higher than in established fracture specific classifications and comparable to the AO classification of pediatric long bone fractures. Some mistakes were due to a low quality of the X-rays and some due to difficulties to classify the fractures themselves. Improvements include a more precise definition of the metaphysis and the kind of displacement. Overall the LiLa classification should still be considered as an alternative for classifying pediatric long bone fractures.
目前有两种针对儿童长骨骨折的特定分类系统：儿童长骨骨折的AO分类（PCCF）和儿童长骨骨折的LiLa分类（LiLa分类）。与成人长骨骨折的AO分类相比，这两种分类系统仍未广泛应用。
在12个月的时间里，专家和非专家根据LiLa分类对儿童所有长骨骨折进行记录和分类。根据科恩（kappa）计算观察者内和观察者间的可靠性。
共分类了408例骨折。骨骼和骨段位置的观察者内可靠性显示出几乎完美的一致性（K = 0.91 - 0.95），骨折形态（关节/骨干骨折）也是如此（K = 0.87 - 0.93）。由于在第二轮分类中对骨折移位的判断不同，整个分类的观察者内可靠性显示出中等一致性（K = 0.53 - 0.58）。观察者间可靠性显示出中等一致性（K = 0.55），这通常是由于X线质量较差。由于难以准确界定干骺端与骨干的过渡区域，还出现了进一步的差异。
LiLa分类适用于儿童长骨骨折的分类，在大多数情况下对用户友好。其可靠性高于已有的特定骨折分类，与儿童长骨骨折的AO分类相当。一些错误是由于X线质量差，还有一些是由于骨折本身难以分类。改进措施包括更精确地定义干骺端和移位类型。总体而言，LiLa分类仍应被视为儿童长骨骨折分类的一种替代方法。
