Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
J Orthop Surg Res. 2020 Sep 23;15(1):438. doi: 10.1186/s13018-020-01966-2.
Although the Neer classification is widely used for the assessment of proximal humeral fractures, its reproducibility has been challenged. The purpose of this study was to evaluate the reproducibility of the conventional Neer classification and a modified classification that defined fracture displacement with respect to the humeral head fragment.
The fracture patterns in 80 cases of proximal humeral fractures were independently assessed by 6 observers. The cases were grouped according to the conventional Neer classification using radiographs followed by computed tomography (CT) scans by each examiner twice with a 1-month interval. The fractures were then classified with the modified Neer classification, which defined displacement of the fragment as separation of more than 1 cm or angulation of more than 45° from the humeral head fragment, twice with a 1-month interval. Kappa coefficients of the conventional and modified Neer classifications were compared.
The modified classification showed significantly higher intra-observer agreement than the conventional classification, both for radiographs (P = .028) and for CT scans (P = .043). Intra-observer agreement was also significantly higher for the modified classification than for the conventional classification, both for radiographs (P = .001) and for CT scans (P < .001).
The present study showed that agreement for the Neer classification could be improved when fracture displacement was defined as separation or angulation from the humeral head. Considering vascularity to the humeral head, furthermore, the modified method might be more helpful for predicting patients' prognosis than the conventional Neer classification.
虽然 Neer 分类法被广泛用于评估肱骨近端骨折，但它的可重复性受到了挑战。本研究旨在评估传统 Neer 分类法和改良分类法（定义骨折块相对于肱骨头的移位）的可重复性。
由 6 名观察者分别对 80 例肱骨近端骨折的骨折模式进行独立评估。根据传统 Neer 分类法，将病例分组，然后使用放射摄影和每位检查者的 CT 扫描进行两次评估，间隔 1 个月。然后，使用改良 Neer 分类法对骨折进行分类，该分类法将骨块的移位定义为与肱骨头骨块分离超过 1cm 或成角超过 45°，两次评估间隔 1 个月。比较传统 Neer 分类法和改良 Neer 分类法的kappa 系数。
改良分类法在放射摄影（P=.028）和 CT 扫描（P=.043）方面的观察者内一致性均明显高于传统分类法。改良分类法的观察者内一致性也明显高于传统分类法，无论是在放射摄影（P=.001）还是在 CT 扫描（P <.001）方面。
本研究表明，当定义骨折块相对于肱骨头的移位为分离或成角时，Neer 分类法的一致性可以得到提高。此外，考虑到肱骨头的血供，改良方法可能比传统的 Neer 分类法更有助于预测患者的预后。
