新型 AO/OTA 2018 肱骨近端骨折分类系统的可靠性和可重复性：三种不同分类系统的比较。
Reliability and reproducibility of the new AO/OTA 2018 classification system for proximal humeral fractures: a comparison of three different classification systems.
机构信息
Orthopaedic Clinic, Department of Surgical Sciences, Cagliari State University, Lungomare Poetto 12, 09126, Cagliari, Italy.
Department Economics and Business Science, Cagliari State University, Cagliari, Italy.
出版信息
J Orthop Traumatol. 2020 Mar 12;21(1):4. doi: 10.1186/s10195-020-0543-1.
BACKGROUND
The classification systems for proximal humeral fractures routinely used in clinical practice include the Neer and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 2007 systems. Currently used systems have low inter- and intraobserver reliability. In 2018, AO/OTA introduced a new classification system with the aim of simplifying the coding process, in which the Neer four-part classification was integrated into the fracture description. The aim of the present work is to assess the inter- and intraobserver agreement of the new AO/OTA 2018 compared with the Neer and AO/OTA 2007 classifications.
MATERIALS AND METHODS
A total of 116 radiographs of consecutive patients with proximal humeral fracture were selected and classified by three observers with different levels of experience. All three observers independently reviewed and classified the images according to the Neer, AO/OTA 2007, and new AO/OTA 2018 systems. To determine the intraobserver agreement, the observers reviewed the same set of radiographs after an interval of 8 weeks. The inter- and intraobserver agreement were determined through Cohen's kappa coefficient analysis.
RESULTS
The new AO/OTA 2018 classification showed substantial mean inter- (k = 0.67) and intraobserver (k = 0.75) agreement. These results are similar to the reliability observed for the Neer classification (interobserver, k = 0.67; intraobserver, k = 0.85) but better than those found for the AO/OTA 2007 system, which showed only moderate inter- (k = 0.57) and intraobserver (k = 0.58) agreement. The two more experienced observers showed better overall agreement, but no statistically significant difference was found. No differences were found between surgical experience and agreement regarding specific fracture types or groups.
CONCLUSIONS
The results showed that the Neer system still represents the more reliable and reproducible classification. However, the new AO/OTA 2018 classification improved the agreement among observers compared with the AO/OTA 2007 system, while still maintaining substantial descriptive power and simplifying the coding process. The universal modifiers and qualifications, despite their possible complexity, allowed a more comprehensive fracture definition without negatively affecting the reliability or reproducibility of the classification system.
LEVEL OF EVIDENCE
Level III, diagnostic studies.
背景
临床上常用的肱骨近端骨折分类系统包括 Neer 分类法和 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association（AO/OTA）2007 分类法。目前使用的系统具有较低的观察者间和观察者内可靠性。2018 年，AO/OTA 引入了一种新的分类系统，旨在简化编码过程，其中 Neer 四部分分类法被整合到骨折描述中。本研究旨在评估新的 AO/OTA 2018 分类法与 Neer 分类法和 AO/OTA 2007 分类法的观察者间和观察者内一致性。
材料和方法
选择了 116 例连续的肱骨近端骨折患者的 X 光片，由 3 名具有不同经验水平的观察者进行分类。所有 3 名观察者均根据 Neer、AO/OTA 2007 和新的 AO/OTA 2018 系统独立回顾和分类图像。为了确定观察者内一致性，观察者在 8 周后复查同一组 X 光片。通过 Cohen 的 Kappa 系数分析来确定观察者间和观察者内的一致性。
结果
新的 AO/OTA 2018 分类法显示出中等偏上的平均观察者间（κ=0.67）和观察者内（κ=0.75）一致性。这些结果与 Neer 分类法的可靠性相似（观察者间，κ=0.67；观察者内，κ=0.85），但优于 AO/OTA 2007 系统，后者仅显示出中度的观察者间（κ=0.57）和观察者内（κ=0.58）一致性。两名更有经验的观察者表现出更好的整体一致性，但没有统计学上的显著差异。在特定骨折类型或分组方面，手术经验与一致性之间没有差异。
结论
结果表明，Neer 系统仍然是更可靠和可重复的分类法。然而，与 AO/OTA 2007 系统相比，新的 AO/OTA 2018 分类法提高了观察者之间的一致性，同时仍然保持了实质性的描述能力，并简化了编码过程。通用修饰符和限定符，尽管可能复杂，但其允许更全面的骨折定义，而不会对分类系统的可靠性或可重复性产生负面影响。
证据水平
III 级，诊断研究。
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