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肱骨近端骨折治疗中的不一致：事故性手术者 Homo chirurgicus 与食蟹猕猴 Macaca sylvanus 之间的非控制、盲法、行为对比分析。

Nonsensus in the treatment of proximal humerus fractures: uncontrolled, blinded, comparative behavioural analysis between Homo chirurgicus accidentus and Macaca sylvanus.

机构信息

Hannover Medical School, Trauma Department, Carl-Neuberg-Str 1, 30625 Hannover, Germany

Hannover Medical School, Institute of General Practice, Hannover, Germany.

出版信息

BMJ. 2020 Dec 14;371:m4429. doi: 10.1136/bmj.m4429.

DOI:10.1136/bmj.m4429
PMID:33318031
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7734645/
Abstract

OBJECTIVE

To investigate the inter-rater reliability of Barbary macaques compared with an expert group of surgeons for the choice of treatment and predicted outcome of proximal humerus fractures.

DESIGN

Uncontrolled, blinded, comparative behavioural analysis.

SETTING

Germany and United States.

PARTICIPANTS

10 blinded experts in the field of orthopaedic trauma surgery (), with special focus on upper extremity surgery from Germany and the US, and five Barbary macaques () from a semi-free range enclosure.

MAIN OUTCOME MEASURES

The reliability of agreement between raters assessed with Fleiss' ĸ.

RESULTS

Barbary macaques seem to have inferior inter-rater reliability in comparison with experts for choice of treatment (non-surgical surgical), but for the geriatric age group most frequently affected by proximal humeral fractures, they performed similarly to the experts in their choices of treatment and choice of surgical procedure. Agreement about predicted outcome was poor among the macaques and slight among the experts. All experts almost always predicted the outcome incorrectly and tended to underestimate it. While only 4 (4.4%) of 90 experts' predictions were correct, 13 (28.9%) of 45 macaques' predictions were correct.

CONCLUSIONS

Consensus on treatment and expected outcomes of proximal humeral fractures is lacking even beyond the human species. Although Barbary macaques tend to predict the clinical outcome more accurately, their reliability to assist surgeons in making a consistent decision is limited. Future high quality research is needed to guide surgeons' decision making on the optimal treatment of this common injury.

摘要

目的

研究巴巴里猕猴（Barbary macaques）与骨科创伤外科专家小组在选择治疗方法和预测肱骨头骨折预后方面的评分者间信度。

设计

非控制、盲法、对比行为分析。

地点

德国和美国。

参与者

10 名来自德国和美国的骨科创伤外科专家（），特别关注上肢手术，以及来自半自由放养围栏的 5 只巴巴里猕猴（）。

主要观察指标

采用 Fleiss' κ 评估评分者间一致性的可靠性。

结果

与专家相比，猕猴在治疗方法（非手术 手术）选择方面的评分者间信度较差，但对于最常发生肱骨头骨折的老年人群，它们在治疗方法和手术选择方面与专家的选择相似。猕猴对预测结果的一致性较差，而专家的一致性稍好。所有专家几乎总是错误预测结果，且倾向于低估结果。只有 90 名专家中的 4 名（4.4%）预测结果正确，而 45 名猕猴中的 13 名（28.9%）预测结果正确。

结论

即使在人类之外，对于肱骨头骨折的治疗和预期结果也缺乏共识。尽管巴巴里猕猴在预测临床结果方面往往更准确，但它们在帮助外科医生做出一致决策方面的可靠性有限。需要进行高质量的未来研究，以指导外科医生对这种常见损伤的最佳治疗方法做出决策。

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