Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR.
Medical Data Research Center, Providence St. Vincent Medical Center, Portland, OR.
J Arthroplasty. 2019 Jul;34(7S):S277-S281. doi: 10.1016/j.arth.2019.02.062. Epub 2019 Mar 7.
The Vancouver classification of periprosthetic femur fractures divides B1 and B2 subtypes based on the stability of the femoral stem. However, this classification was described and validated with cemented femoral stems. We sought to assess reliability and validity of the Vancouver classification in patients with cementless femoral stems.
This is a blinded radiographic study which included patients treated for Vancouver B cementless periprosthetic femur fractures between February 2007 and December 2017. Adult reconstruction-trained and trauma fellowship-trained orthopedic surgeons graded all preoperative radiographs using the Vancouver classification on 3 separate occasions. Interobserver and intraobserver reliability was assessed via the Fleiss' kappa statistic. Validity was assessed via accuracy between radiographic and intraoperative assessments. The Landis and Koch criteria were used to interpret the kappa values.
Fifty-three patients with Vancouver B fractures (B1, 8; B2, 45) around a cementless femoral stem were included in the study. Five reconstruction-trained and 5 trauma-trained orthopedic surgeons graded all radiographs. The interobserver reliability kappa value was 0.45 (moderate agreement), with all raters agreeing on only 43% of radiographs. Validity analysis showed demonstrated 79% agreement. Overall, 20% (range, 14%-24%) of unstable B2 fractures were misread as B1 fractures. Intraobserver reliability was 0.71 between readings.
The reliability of the Vancouver classification for cementless total hip arthroplasty is lower than previously described in cemented femoral stems. Radiographic assessment alone may be inadequate for determination of stability of cementless stems in periprosthetic femur fractures.
Level III therapeutic study: retrospective comparative study.
温哥华假体周围股骨骨折分类根据股骨柄的稳定性将 B1 和 B2 亚型进行划分。然而，该分类是在使用粘结股骨柄的情况下进行描述和验证的。我们试图评估温哥华分类在非粘结股骨柄患者中的可靠性和有效性。
这是一项盲法放射学研究，纳入了 2007 年 2 月至 2017 年 12 月期间接受温哥华 B 型非粘结假体周围股骨骨折治疗的患者。成人重建培训和创伤 fellowship培训的骨科医生在 3 次不同的时间使用温哥华分类对所有术前 X 线片进行分级。通过 Fleiss'kappa 统计评估观察者间和观察者内的可靠性。通过 X 线片和术中评估之间的准确性来评估有效性。使用 Landis 和 Koch 标准来解释 kappa 值。
研究纳入了 53 例非粘结股骨柄周围温哥华 B 型骨折（B1，8 例；B2，45 例）患者。5 名重建培训和 5 名创伤培训的骨科医生对所有 X 线片进行了分级。观察者间可靠性 kappa 值为 0.45（中度一致性），所有评分者仅在 43%的 X 线片中达成一致。有效性分析显示，79%的结果一致。总体而言，20%（范围，14%-24%）不稳定的 B2 型骨折被误读为 B1 型骨折。观察者内可靠性在两次读数之间为 0.71。
与先前在粘结股骨柄中描述的情况相比，温哥华分类在非粘结全髋关节置换中的可靠性较低。单独的 X 线片评估可能不足以确定假体周围股骨骨折中非粘结股骨柄的稳定性。
III 级治疗研究：回顾性比较研究。
