Ramos Lucas Sacramento, Gonçalves Henrique Mansur, Freitas Anderson, Oliveira Marcio de Paiva, Lima Diogo Marcelino Santos, Carmargo Welvis Soares
Departamento de Ortopedia e Traumatologia, Hospital Regional do Gama, Brasília, DF, Brasil.
Departamento de Medicina, Universidade de Brasília, Brasília, DF, Brasil.
Rev Bras Ortop (Sao Paulo). 2021 Jun;56(3):372-378. doi: 10.1055/s-0040-1718508. Epub 2020 Dec 18.
The present study aims to analyze the intra- and interobserver reproducibility of the Lauge-Hansen, Danis-Weber, and Arbeitsgemeinschaft für Osteosynthesefragen (AO) classifications for ankle fractures, and the influence of evaluators training stage in these assessments. Anteroposterior (AP), lateral and true AP radiographs from 30 patients with ankle fractures were selected. All images were evaluated by 11 evaluators at different stages of professional training (5 residents and 6 orthopedic surgeons), at 2 different times. Intra- and interobserver agreement was analyzed using the weighted Kappa coefficient. Student t-tests for paired samples were applied to detect significant differences in the degree of interobserver agreement between instruments. Intraobserver analysis alone had a significant agreement in all classifications. Moderate to excellent interobserver agreement was highly significant ( ≤ 0.0001) for the Danis-Weber classification. The Danis-Weber classification showed, on average, a significantly higher degree of agreement than the remaining classification systems ( ≤ 0.0001). The Danis-Weber classification presented the highest reproducibility among instruments and the evaluator's little experience had no negative influence on the reproducibility of ankle fracture classifications. .
本研究旨在分析Lauge-Hansen、Danis-Weber和骨科学术协会（AO）踝关节骨折分类系统在观察者内和观察者间的可重复性，以及评估者培训阶段对这些评估的影响。选择30例踝关节骨折患者的前后位（AP）、侧位和真正AP位X线片。所有图像由11名处于不同专业培训阶段的评估者（5名住院医师和6名骨科医生）在两个不同时间进行评估。使用加权Kappa系数分析观察者内和观察者间的一致性。应用配对样本的学生t检验来检测不同分类系统之间观察者间一致性程度的显著差异。仅观察者内分析在所有分类中都有显著的一致性。对于Danis-Weber分类，观察者间的中度至高度一致性非常显著（P≤0.0001）。平均而言，Danis-Weber分类的一致性程度明显高于其他分类系统（P≤0.0001）。Danis-Weber分类在所有分类系统中具有最高的可重复性，评估者经验不足对踝关节骨折分类的可重复性没有负面影响。
