Byun Seong-Eun, Shon Oog-Jin, Sim Jae-Ang, Joo Yong-Bum, Kim Ji-Wan, Na Young-Gon, Choi Wonchul
Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam 13497, Korea.
Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu 42415, Korea.
J Clin Med. 2021 Jul 23;10(15):3256. doi: 10.3390/jcm10153256.
We investigated whether interrater reliabilities of the AO/OTA classification of patellar fracture change with the imaging modalities applied, including plain radiography and two- and three-dimensional (2-D and 3-D) computed tomography (CT). Seven orthopedic specialists and four orthopedic residents completed a survey of 50 patellar fractures to classify the fractures according to the AO/OTA classification for patellar fractures. Initially, the survey was conducted using plain radiography only, then with 2-D CT introduced three weeks later and 3-D CT introduced six weeks later. Fleiss' Kappa coefficients were calculated to determine interrater reliability. The overall interrater reliability of the AO/OTA classifications was 0.40 (95% CI, 0.38-0.42) with plain radiography only and 0.43 (95% CI, 0.41-0.45) with the addition of 2-D CT. With the addition of 3-D CT, the reliability was significantly improved to 0.54 (95% CI, 0.52-0.56). In specialists, interrater reliability of the classifications was moderate with all three imaging modalities. With the use of 3-D CT, interrater reliability of the classification was 0.53 (95% CI, 0.50-0.56), which was significantly higher than that with the use of 2-D CT (κ = 0.45; 95% CI, 0.42-0.48). In residents, interrater reliability of the classification was 0.30 (95% CI, 0.24-0.36) with plain radiography. The reliability improved to 0.49 (95% CI, 0.43-0.56) with the addition of 2-D CT, which was significantly higher than that with plain radiography only. The use of 3-D CT imaging improved interrater reliability of the classification. Therefore, surgeons, especially residents, may benefit from using 3-D CT imaging for classifying and planning the treatment of patellar fractures.
我们研究了应用不同成像方式（包括X线平片、二维和三维（2-D和3-D）计算机断层扫描（CT））时，AO/OTA髌骨骨折分类的评分者间信度是否会发生变化。7名骨科专家和4名骨科住院医师对50例髌骨骨折进行了调查，以根据AO/OTA髌骨骨折分类法对骨折进行分类。最初，仅使用X线平片进行调查，三周后引入二维CT，六周后引入三维CT。计算Fleiss' Kappa系数以确定评分者间信度。仅使用X线平片时，AO/OTA分类的总体评分者间信度为0.40（95%CI，0.38-0.42），添加二维CT后为0.43（95%CI，0.41-0.45）。添加三维CT后，信度显著提高至0.54（95%CI，0.52-0.56）。在专家中，三种成像方式下分类的评分者间信度均为中等。使用三维CT时，分类的评分者间信度为0.53（95%CI，0.50-0.56），显著高于使用二维CT时（κ = 0.45；95%CI，0.42-0.48）。在住院医师中，仅使用X线平片时分类的评分者间信度为0.30（95%CI，0.24-0.36）。添加二维CT后，信度提高至0.49（95%CI，0.43-0.56），显著高于仅使用X线平片时。使用三维CT成像提高了分类的评分者间信度。因此，外科医生，尤其是住院医师，在对髌骨骨折进行分类和制定治疗方案时使用三维CT成像可能会受益。
