Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
Orthop Traumatol Surg Res. 2019 Nov;105(7):1407-1412. doi: 10.1016/j.otsr.2019.07.011. Epub 2019 Sep 18.
Two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) have been increasingly used in various intra-articular fractures including pilon fracture. However, no study has investigated intraobserver and interobserver reliabilities of pilon fracture classification using 3D CT images.
(1) Intraobserver and interobserver agreements of fracture classifications and treatment recommendations will improve by using 2D CT images compared to using plain radiographs only; (2) agreements will improve by adding 3D CT images compared to adding 2D CT images; and (3) agreements of orthopedic residents rather than specialists will be influenced more by imaging modality.
Ten orthopedic specialists and 10 residents completed a survey to classify the fractures according to the Rüedi-Allgöwer and AO/OTA classifications and to select treatment options using 25 pilon fracture images. The survey was conducted using plain radiographs, with 2D and 3D CT images introduced 3 and 6weeks later, respectively. Kappa coefficients were calculated to determine reliabilities.
Intraobserver reliabilities for fracture classifications in specialists significantly improved by using 2D images compared to using plain radiographs only. Addition of 3D CT did not significantly improve intraobserver reliabilities compared to those with 2D CT. Use of 2D CT images significantly improved overall interobserver agreement of both classifications, with the improvement being greater for residents. Use of 3D CT images did not improve the interobserver reliability of both classifications. Overall interobserver reliabilities for treatment recommendations did not significantly differ according to the imaging modality. However, interobserver agreement among residents significantly improved from slight agreement using radiographs only to fair agreement using 2D CT images.
Intraobserver and interobserver reliabilities of pilon fracture classification and treatment recommendations did not improve between using 3D and 2D CT. Using 2D CT images improved the intraobserver and interobserver reliabilities of the fracture classifications in specialists and the interobserver reliabilities of the fracture classifications and the treatment recommendations in residents.
IV, case control study.
二维（2D）和三维（3D）计算机断层扫描（CT）已越来越多地用于各种关节内骨折，包括 Pilon 骨折。然而，目前还没有研究调查使用 3D CT 图像对 Pilon 骨折进行分类的观察者内和观察者间的可靠性。
（1）与仅使用平片相比，使用 2D CT 图像可提高骨折分类和治疗建议的观察者内和观察者间的一致性；（2）与添加 2D CT 图像相比，添加 3D CT 图像将提高一致性；（3）与专家相比，影像模式对骨科住院医师的影响更大。
10 名骨科专家和 10 名住院医师完成了一项调查，根据 Rüedi-Allgöwer 和 AO/OTA 分类对骨折进行分类，并使用 25 个 Pilon 骨折图像选择治疗方案。调查使用平片进行，分别在 3 周和 6 周后引入 2D 和 3D CT 图像。计算 Kappa 系数以确定可靠性。
与仅使用平片相比，专家的骨折分类观察者内可靠性使用 2D 图像显著提高。与使用 2D CT 图像相比，添加 3D CT 图像并未显著提高观察者内可靠性。使用 2D CT 图像显著提高了两种分类的总体观察者间一致性，对住院医师的改善更大。使用 3D CT 图像并未提高两种分类的观察者间可靠性。根据成像方式，治疗建议的总体观察者间可靠性没有显著差异。然而，住院医师之间的观察者间一致性仅使用平片时为轻度一致，使用 2D CT 图像时则为适度一致，显著提高。
使用 3D 和 2D CT 并未提高 Pilon 骨折分类和治疗建议的观察者内和观察者间的可靠性。使用 2D CT 图像提高了专家的骨折分类的观察者内和观察者间的可靠性，以及住院医师的骨折分类和治疗建议的观察者间的可靠性。
IV，病例对照研究。
