Roll Christina, Schirmbeck Johanna, Müller Franz, Neumann Carsten, Kinner Bernd
Department of Trauma and Reconstructive Surgery, University of Regensburg, Regensburg, Germany.
Department of Trauma and Reconstructive Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany.
Foot Ankle Int. 2016 Nov;37(11):1211-1217. doi: 10.1177/1071100716660824. Epub 2016 Aug 16.
The interpretation of CT scans for the evaluation of calcaneal fractures is difficult. Three-dimensional (3D) reconstruction (volume rendering technique [VRT]) has been valuable in the evaluation of irregularly shaped bones. However, their value for the analysis of calcaneal fractures is still debated. Therefore, the objective of this study was to assess the effect of additional use of 3D CTs in calcaneal fractures.
In a prospective multicenter study, the CT data set of 5 different fractures was presented to 57 evaluators. First, the participating surgeons were asked to assess the fractures on the basis of axial, coronal, and sagittal reconstructions using a multiple-choice questionnaire. Second, 3D reconstructions (VRT) were presented. The CT scans were validated by the intraoperative findings and the results were compared to the model solution of 3 foot and ankle surgeons. Intra- and interrater reliabilities were calculated.
The proportion of intraobserver agreement was 82%, with Cohen kappa of κ = 0.748 (P < .001). Interrater agreement varied between 0.772 (P = .006) for the assessment of concomitant fractures and 0.987 (P < .001) for the suggested approach. The evaluation of several items improved after presentation of the 3D CTs (Cochrane Q test, P < .001). The benefit of 3D imaging was higher in inexperienced surgeons and complex fractures (Friedman test P < .001).
The evaluation of CT scans of calcaneal fractures was improved by the additional use of 3D images (VRT).
Level II, prospective comparative study.
利用CT扫描评估跟骨骨折具有一定难度。三维（3D）重建（容积再现技术[VRT]）在评估不规则形状骨骼方面具有重要价值。然而，其在跟骨骨折分析中的价值仍存在争议。因此，本研究旨在评估额外使用3D CT对跟骨骨折的影响。
在一项前瞻性多中心研究中，向57名评估者展示了5种不同骨折的CT数据集。首先，要求参与的外科医生基于轴位、冠状位和矢状位重建，通过多项选择题问卷对骨折进行评估。其次，展示3D重建（VRT）图像。CT扫描结果通过术中发现进行验证，并将结果与3位足踝外科医生的模型解决方案进行比较。计算观察者内和观察者间的可靠性。
观察者内一致性比例为82%，Cohen κ系数为κ = 0.748（P <.001）。观察者间一致性在评估合并骨折时为0.772（P =.006），在建议的治疗方法评估中为0.987（P <.001）。展示3D CT后，多项评估指标得到改善（Cochrane Q检验，P <.001）。3D成像对经验不足的外科医生和复杂骨折的益处更高（Friedman检验，P <.001）。
额外使用3D图像（VRT）可改善跟骨骨折CT扫描的评估。
II级，前瞻性比较研究。
