Krappinger Dietmar, Kaser Verena, Merkel Anke, Neururer Sabrina, Lindtner Richard A
Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
Arch Orthop Trauma Surg. 2021 May;141(5):861-869. doi: 10.1007/s00402-020-03546-9. Epub 2020 Jul 31.
Classification and management of osteoporotic pelvic ring injuries (OPRI) continue to pose a considerable challenge to orthopaedic traumatologists. The currently used fragility fractures of the pelvis (FFP) classification of OPRI has recently been shown to have significant weaknesses. The aim of this study therefore was to propose a new, simple, yet comprehensive alphanumeric classification (ANC) of OPRI and to assess its intra- and interobserver reliability. Furthermore, its potential advantages over the FFP classification are discussed.
One hundred consecutive CT scans from patients with OPRI were evaluated by three orthopaedic traumatologists with varying levels of experience and one musculoskeletal radiologist. Intra- and interobserver reliability of the proposed classification system was assessed using weighted kappa (κ) statistics and percentage agreement. In addition, the Fleiss' kappa statistic was computed to assess interobserver agreement among all four raters.
Overall intraobserver reliability of the proposed ANC was substantial [κ ranging from 0.71 to 0.80; percentage agreement: 70% (range, 67-76%)]. Overall interobserver reliability between pairs of raters was substantial as well [κ ranging from 0.61 to 0.68; percentage agreement: 58% (range, 53-61%)]. For ANC types, groups and subgroups, intra- and interobserver reliability were substantial to almost perfect. Interobserver agreement among all four raters was moderate to substantial, with Fleiss' kappa values of 0.48, 0.69, 0.71 and 0.52 for ANC overall, types, groups and subgroups, respectively.
The proposed ANC of OPRI demonstrated overall reliability comparable to that of the FFP classification. The ANC, however, is simple, more comprehensive, and consistently relates to injury severity.
骨质疏松性骨盆环损伤（OPRI）的分类和管理仍然给骨科创伤外科医生带来巨大挑战。目前使用的OPRI骨盆脆性骨折（FFP）分类最近被证明存在重大缺陷。因此，本研究的目的是提出一种新的、简单但全面的OPRI字母数字分类（ANC），并评估其观察者内和观察者间的可靠性。此外，还讨论了其相对于FFP分类的潜在优势。
三位经验水平不同的骨科创伤外科医生和一位肌肉骨骼放射科医生对100例连续的OPRI患者的CT扫描进行了评估。使用加权kappa（κ）统计和百分比一致性评估所提出分类系统的观察者内和观察者间可靠性。此外，计算Fleiss' kappa统计量以评估所有四位评估者之间的观察者间一致性。
所提出的ANC的总体观察者内可靠性较高[κ范围为0.71至0.80；百分比一致性：70%（范围，67 - 76%）]。评估者对之间总体观察者间可靠性也较高[κ范围为0.61至0.68；百分比一致性：58%（范围，53 - 61%）]。对于ANC类型、组和亚组，观察者内和观察者间可靠性较高至几乎完美。所有四位评估者之间的观察者间一致性为中等至较高，ANC总体、类型、组和亚组的Fleiss' kappa值分别为0.48、0.69、0.71和0.52。
所提出的OPRI的ANC总体可靠性与FFP分类相当。然而，ANC更简单、更全面，且始终与损伤严重程度相关。
