Ryu Seung Min, Park Jae Woo, Moon Jeong Jae, Lim Seung Wan, Kwon Moon Soo, Shon Oog Jin
Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea.
Int Orthop. 2018 Oct;42(10):2451-2458. doi: 10.1007/s00264-018-3853-7. Epub 2018 Feb 26.
The goal of this study was to compare the inter- and intra-observer reliabilities of computed tomography (CT) scans of bicondylar tibial plateau fractures (Bi-TPFs) with or without distraction with a bridging external fixation (EF) as interpreted by inexperienced surgeons.
Patients that underwent CT after distraction with a bridging EF were allocated to group 1 (n = 18), and patients that underwent CT before distraction with a bridging EF were allocated to group 2 (n = 18). Five observers were given plain radiographs and CT images to assess (survey 1) and this assessment was repeated six weeks later (survey 2). Agreements regarding fracture classification and pre-operative planning were evaluated using kappa coefficients. In addition, to evaluate fracture severity, we designed a severity score.
Inter-observer reliabilities for fracture classification and pre-operative planning were higher in group 1 than in group 2. Surveys 1 and 2 revealed similar kappa coefficients in the two study groups. The mean absolute difference (MAD) in severity scores allocated at the two surveys was significantly different between the two groups (P = 0.045). Intra-observer reliabilities of fracture classification and pre-operative planning were also higher in group 1 than in group 2. In addition, level of training was found to have a significant impact on the MAD in severity scores (P = 0.007).
Inter- and intra-observer reliabilities for fracture classification and pre-operative planning were better for inexperienced surgeons when CT was performed after distraction with a bridging EF for Bi-TPFs. Thus, when staged treatment using EF is selected in Bi-TPF patients, the authors suggest that CT scans be performed after distraction with a bridging EF especially for inexperienced surgeons.
本研究的目的是比较由经验不足的外科医生解读的伴有或不伴有桥接外固定（EF）牵引的双髁胫骨平台骨折（Bi-TPF）的计算机断层扫描（CT）图像在观察者间和观察者内的可靠性。
接受桥接EF牵引后进行CT检查的患者被分配到第1组（n = 18），接受桥接EF牵引前进行CT检查的患者被分配到第2组（n = 18）。五名观察者被给予X线平片和CT图像进行评估（调查1），六周后重复该评估（调查2）。使用kappa系数评估骨折分类和术前规划的一致性。此外，为了评估骨折严重程度，我们设计了一个严重程度评分。
第1组骨折分类和术前规划的观察者间可靠性高于第2组。调查1和调查2显示，两个研究组的kappa系数相似。两组在两次调查中分配的严重程度评分的平均绝对差异（MAD）有显著差异（P = 0.045）。第1组骨折分类和术前规划的观察者内可靠性也高于第2组。此外，发现培训水平对严重程度评分的MAD有显著影响（P = 0.007）。
对于经验不足的外科医生，在对Bi-TPF进行桥接EF牵引后进行CT检查时，骨折分类和术前规划的观察者间和观察者内可靠性更好。因此，当在Bi-TPF患者中选择使用EF的分期治疗时，作者建议尤其是对于经验不足的外科医生，应在桥接EF牵引后进行CT扫描。
