Division of Pediatric Orthopaedic Surgery (E.A.E., Z.A.S., C.T.M., J.D., S.N.P., and J.T.) and Department of Radiology (T.M. and A.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229. E-mail address for C.T. Mehlman:
J Bone Joint Surg Am. 2015 Jun 17;97(12):995-1002. doi: 10.2106/JBJS.N.01208.
The purpose of this study was to compare the reliability of triplane fracture classification, displacement measurement, and treatment planning with the use of radiographs with and without computed tomography.
One pediatric radiologist, one musculoskeletal radiologist, and three fellowship-trained pediatric orthopaedic surgeons rated a spectrum of twenty-five triplane fractures with use of radiographs alone and then with computed tomography scans on two separate occasions (two to four weeks apart). Raters classified the fracture pattern with use of the Rapariz classification system, measured the maximum intra-articular displacement, and drew the fracture on four outlines of the distal part of the tibia: one lateral view, one anteroposterior view, one axial view above the tibial physis, and one axial view below the physis. Reliability was assessed with kappa values and intraclass correlation coefficients.
The Rapariz triplane fracture classification had poor inter-rater reliability (a kappa of 0.17) and intra-rater reliability (a kappa of 0.31) with radiographs alone but moderate inter-rater reliability (a kappa of 0.41) and intra-rater reliability (a kappa of 0.54) with the addition of computed tomography. After reviewing computed tomography, raters changed the fracture pattern in 46% of ratings, the displacement from ≤2 mm to >2 mm in 39% of ratings, the treatment from nonoperative to operative in 27% of ratings, and either the orientation or number of screws in 41% of ratings.
Computed tomography had a definite impact on the fracture classification, displacement, and treatment plan, supporting its use as an adjunct to radiographs for the treatment of pediatric triplane fractures.
本研究的目的是比较在使用和不使用计算机断层扫描（CT）的情况下，通过 X 线片评估三平面骨折的可靠性，包括骨折分类、移位测量和治疗计划。
一名儿科放射科医师、一名肌肉骨骼放射科医师和三名经过 fellowship培训的小儿矫形外科医师，分别两次（间隔两到四周）单独使用 X 线片和 X 线片加 CT 扫描对 25 例三平面骨折进行评估。评估者使用 Rapariz 分类系统对骨折类型进行分类，测量最大关节内移位，并在胫骨远端的四个轮廓上绘制骨折：一个外侧位，一个前后位，一个胫骨骨骺上方的轴位，一个骨骺下方的轴位。使用kappa 值和组内相关系数评估可靠性。
Rapariz 三平面骨折分类在单独使用 X 线片时，组内和组间可靠性均较差（kappa 值分别为 0.17 和 0.41），但在添加 CT 后，组内和组间可靠性均为中等（kappa 值分别为 0.31 和 0.54）。在查看 CT 后，评估者在 46%的评分中改变了骨折类型，在 39%的评分中改变了 2mm 以上的移位，在 27%的评分中改变了治疗方法（从非手术改为手术），在 41%的评分中改变了螺钉的方向或数量。
CT 对骨折分类、移位和治疗计划有明确影响，支持将其作为 X 线片的辅助手段用于治疗小儿三平面骨折。
