FACTS多中心研究小组对青少年锁骨中段骨折的影像学评估可靠性
Reliability of Radiographic Assessments of Adolescent Midshaft Clavicle Fractures by the FACTS Multicenter Study Group.
作者信息
Li Ying, Donohue Kyna S, Robbins Christopher B, Pennock Andrew T, Ellis Henry B, Nepple Jeffrey J, Pandya Nirav, Spence David D, Willimon Samuel Clifton, Heyworth Benton E
机构信息
*Department of Orthopaedic Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; †Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA; ‡Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, CA; §Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX; ‖Department of Orthopaedic Surgery, Washington University, St. Louis, MO; ¶Department of Orthopaedic Surgery, University of California, San Francisco, CA; **Department of Orthopaedic Surgery, Campbell Clinic, Memphis, TN; and ††Children's Orthopaedics of Atlanta, Atlanta, GA.
出版信息
J Orthop Trauma. 2017 Sep;31(9):479-484. doi: 10.1097/BOT.0000000000000877.
OBJECTIVES
There is a recent trend toward increased surgical treatment of displaced midshaft clavicle fractures in adolescents. The primary purpose of this study was to evaluate the intrarater and interrater reliability of clavicle fracture classification systems and measurements of displacement, shortening, and angulation in adolescents. The secondary purpose was to compare 2 different measurement methods for fracture shortening.
METHODS
This study was performed by a multicenter study group conducting a prospective, comparative, observational cohort study of adolescent clavicle fractures. Eight raters evaluated 24 deidentified anteroposterior clavicle radiographs selected from patients 10-18 years of age with midshaft clavicle fractures. Two clavicle fracture classification systems were used, and 2 measurements for shortening, 1 measurement for superior-inferior displacement, and 2 measurements for fracture angulation were performed. A minimum of 2 weeks after the first round, the process was repeated. Intraclass correlation coefficients were calculated.
RESULTS
Good to excellent intrarater and interrater agreement was achieved for the descriptive classification system of fracture displacement, direction of angulation, presence of comminution, and all continuous variables, including both measurements of shortening, superior-inferior displacement, and degrees of angulation. Moderate agreement was achieved for the Arbeitsgemeinschaft für Osteosynthesefragen classification system overall. Mean shortening by 2 different methods were significantly different from each other (P < 0.0001).
CONCLUSIONS
Most radiographic measurements performed by investigators in a multicenter, prospective cohort study of adolescent clavicle fractures demonstrated good-to-excellent intrarater and interrater reliability. Future consensus on the most accurate and clinically appropriate measurement method for fracture shortening is critical.
目的
近期青少年中段锁骨骨折的手术治疗有增加的趋势。本研究的主要目的是评估青少年锁骨骨折分类系统以及移位、短缩和成角测量的评估者内和评估者间可靠性。次要目的是比较两种不同的骨折短缩测量方法。
方法
本研究由一个多中心研究小组进行，对青少年锁骨骨折开展一项前瞻性、对比性观察队列研究。8名评估者对从10至18岁中段锁骨骨折患者中选取的24份去除身份标识的锁骨前后位X线片进行评估。使用了两种锁骨骨折分类系统，并对短缩进行了2种测量、对上下移位进行了1种测量、对骨折成角进行了2种测量。在第一轮评估至少2周后，重复该过程。计算组内相关系数。
结果
对于骨折移位的描述性分类系统、成角方向、粉碎情况以及所有连续变量（包括短缩、上下移位和成角程度的两种测量），评估者内和评估者间均达成了良好至优秀的一致性。总体而言，AO分类系统达成了中等一致性。两种不同方法测得的平均短缩有显著差异（P < 0.0001）。
结论
在一项针对青少年锁骨骨折的多中心前瞻性队列研究中，研究人员进行的大多数影像学测量显示出良好至优秀的评估者内和评估者间可靠性。未来就骨折短缩最准确且临床适用的测量方法达成共识至关重要。
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