Hutt J R B, Ortega-Briones A, Daurka J S, Bircher M D, Rickman M S
St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London SW17 0QT, UK.
St Mary's Hospital, Praed Street, Paddington, London W2 1NY, UK.
Bone Joint J. 2015 Aug;97-B(8):1139-43. doi: 10.1302/0301-620X.97B8.33653.
The most widely used classification system for acetabular fractures was developed by Judet, Judet and Letournel over 50 years ago primarily to aid surgical planning. As population demographics and injury mechanisms have altered over time, the fracture patterns also appear to be changing. We conducted a retrospective review of the imaging of 100 patients with a mean age of 54.9 years (19 to 94) and a male to female ratio of 69:31 seen between 2010 and 2013 with acetabular fractures in order to determine whether the current spectrum of injury patterns can be reliably classified using the original system. Three consultant pelvic and acetabular surgeons and one senior fellow analysed anonymous imaging. Inter-observer agreement for the classification of fractures that fitted into defined categories was substantial, (κ = 0.65, 95% confidence interval (CI) 0.51 to 0.76) with improvement to near perfect on inclusion of CT imaging (κ = 0.80, 95% CI 0.69 to 0.91). However, a high proportion of injuries (46%) were felt to be unclassifiable by more than one surgeon; there was moderate agreement on which these were (κ = 0.42 95% CI 0.31 to 0.54). Further review of the unclassifiable fractures in this cohort of 100 patients showed that they tended to occur in an older population (mean age 59.1 years; 22 to 94 vs 47.2 years; 19 to 94; p = 0.003) and within this group, there was a recurring pattern of anterior column and quadrilateral plate involvement, with or without an incomplete posterior element injury.
50多年前，朱代（Judet）、朱代和勒图尔内（Letournel）开发了应用最为广泛的髋臼骨折分类系统，主要用于辅助手术规划。随着时间的推移，人口统计学特征和损伤机制发生了变化，骨折类型似乎也在改变。我们对2010年至2013年间收治的100例髋臼骨折患者的影像学资料进行了回顾性研究，这些患者的平均年龄为54.9岁（19至94岁），男女比例为69:31，目的是确定当前的损伤类型谱能否使用原始系统进行可靠分类。三位骨盆和髋臼外科顾问医师以及一位高级研究员分析了匿名影像学资料。对于符合既定类别的骨折分类，观察者间的一致性较高（κ = 0.65，95%置信区间（CI）为0.51至0.76），纳入CT影像后一致性提高到近乎完美（κ = 0.80，95%CI为0.69至0.91）。然而，超过一名外科医生认为很大一部分损伤（46%）无法分类；对于哪些损伤属于此类存在中度一致性（κ = 0.42，95%CI为0.31至0.54）。对这100例患者中无法分类的骨折进行进一步复查发现，这些骨折往往发生在年龄较大的人群中（平均年龄59.1岁；22至94岁，而其他患者平均年龄为47.2岁；19至94岁；p = 0.003），在这个群体中，存在前柱和四边形板受累的反复出现的模式，伴有或不伴有后部结构不完全损伤。
