评估改良的Gartland分类系统对伸直型肱骨髁上骨折的可靠性。
Assessing the reliability of the modified Gartland classification system for extension-type supracondylar humerus fractures.
作者信息
Teo T L, Schaeffer E K, Habib E, Cherukupalli A, Cooper A P, Aroojis A, Sankar W N, Upasani V V, Carsen S, Mulpuri K, Reilly C
机构信息
Department of Orthopaedic Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
Department of Paediatric Orthopaedics, B.J. Wadia Hospital for Children, Mumbai, India.
出版信息
J Child Orthop. 2019 Dec 1;13(6):569-574. doi: 10.1302/1863-2548.13.190005.
PURPOSE
The Gartland extension-type supracondylar humerus (SCH) fracture is the most common paediatric elbow fracture. Treatment options range from nonoperative treatment (taping or casting) to operative treatments (closed reduction and percutaneous pinning or open reduction). Classification variability between surgeons is a potential contributing factor to existing controversy over treatment options for type II SCH fractures. This study investigated levels of agreement in extension-type SCH fracture classification using the modified Gartland classification system.
METHODS
A retrospective review was conducted on 60 patients aged between two and 12 years who had sustained an extension-type SCH fracture and received operative or nonoperative treatment at a tertiary children's hospital. Baseline radiographs were provided, and surgeons were asked to classify the fractures as type I, IIA, IIB or III according to the modified Gartland classification. Respondents were then asked to complete a second round of classifications using reshuffled radiographs. Weighted kappa values were calculated to assess interobserver and intraobserver levels of agreement.
RESULTS
In all, 21 paediatric orthopaedic surgeons responded to the survey and 15 completed a second round of ratings. Interobserver agreement for classification based on the Gartland criteria between surgeons was substantial with a kappa of 0.679 (95% confidence interval (CI) 0.501 to 0.873). Intraobserver agreement was substantial with a kappa of 0.796, (95% CI 0.628 to 0.864).
CONCLUSION
Radiographic classification of extension-type SCH fractures demonstrated substantial agreement both between and within surgeon raters. Therefore, classification variability may not be a major contributing factor to the treatment controversy for type II SCH fractures and treatment variability may be due to differences in surgeon preferences.
LEVEL OF EVIDENCE
III.
目的
Gartland伸展型肱骨髁上骨折（SCH）是最常见的小儿肘部骨折。治疗选择范围从非手术治疗（绑扎或石膏固定）到手术治疗（闭合复位经皮穿针或切开复位）。外科医生之间的分类差异是导致II型SCH骨折治疗方案存在争议的一个潜在因素。本研究使用改良的Gartland分类系统调查伸展型SCH骨折分类的一致性水平。
方法
对60例年龄在2至12岁之间、发生伸展型SCH骨折并在一家三级儿童医院接受手术或非手术治疗的患者进行回顾性研究。提供了基线X线片，并要求外科医生根据改良的Gartland分类将骨折分为I型、IIA 型、IIB型或III型。然后要求受访者使用重新排列的X线片完成第二轮分类。计算加权kappa值以评估观察者间和观察者内的一致性水平。
结果
共有21名小儿骨科医生回复了调查，其中15名完成了第二轮评分。外科医生之间基于Gartland标准的分类观察者间一致性较高，kappa值为0.679（95%置信区间（CI）0.501至0.873）。观察者内一致性较高，kappa值为0.796（95%CI 0.628至0.864）。
结论
伸展型SCH骨折的X线分类在外科医生评分者之间和评分者内部均显示出较高的一致性。因此，分类差异可能不是II型SCH骨折治疗争议的主要因素，治疗差异可能是由于外科医生偏好不同。
证据级别
III级。
Zotero 插件