Fagotti Lorenzo, Ejnisman Leandro, Gurgel Henrique DE Melo Campos, Miyahara Helder DE Souza, Croci Alberto Tesconi, Vicente Jose Ricardo Negreiros
. Hip Group, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Acta Ortop Bras. 2018 Jan-Feb;26(1):11-15. doi: 10.1590/1413-785220182601175203.
To determine the reliability of two classification methods for wound hematoma after total hip replacement.
This prospective cohort study was conducted on patients who underwent total hip replacement for hip osteoarthritis between May 2014 and April 2015. Epidemiological, surgical, and functional data were assessed. Two experienced hip surgeons evaluated 75 pictures of wounds taken 24 hours after surgery. Both evaluators performed the analysis twice, with a 6-week interval between the two analyses. The subjective classification was divided into four different categories describing the hematoma: absent, mild, moderate, and severe. The objective classification was derived from mathematical calculation of the area of the hematoma using a grid superimposed on a picture of the wound.
The subjective classification demonstrated an intra-rater agreement of more than 70%, while kappa values showed poor to moderate inter-rater reliability. The objective classification based on mathematical measurements of the hematoma area was more reliable, with good to excellent intra- and inter-rater reliability.
The objective classification demonstrated higher intra- and inter-rater reliability. The classification methods used in this study could serve as a useful instrument for orthopedic surgeons, researchers, and health care providers when assessing wound hematomas after total hip replacement. Level of Evidence II; Development of diagnostic criteria on consecutive patients (with universally applied reference ''gold'' standard).
确定全髋关节置换术后伤口血肿两种分类方法的可靠性。
本前瞻性队列研究针对2014年5月至2015年4月期间因髋骨关节炎接受全髋关节置换术的患者进行。评估了流行病学、手术和功能数据。两名经验丰富的髋关节外科医生评估了术后24小时拍摄的75张伤口图片。两名评估者均进行了两次分析，两次分析间隔6周。主观分类分为描述血肿的四个不同类别：无、轻度、中度和重度。客观分类源自使用叠加在伤口图片上的网格对血肿面积进行数学计算。
主观分类显示评分者内一致性超过70%，而kappa值显示评分者间可靠性较差至中等。基于血肿面积数学测量的客观分类更可靠，评分者内和评分者间可靠性良好至优秀。
客观分类显示出更高的评分者内和评分者间可靠性。本研究中使用的分类方法可为骨科医生、研究人员和医疗保健提供者在评估全髋关节置换术后伤口血肿时提供有用的工具。证据等级II；对连续患者制定诊断标准（采用普遍适用的参考“金”标准）。
