Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany.
Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle, Halle, Germany.
BMC Musculoskelet Disord. 2021 Nov 29;22(1):992. doi: 10.1186/s12891-021-04882-6.
Osteoporotic fractures of the pelvis (OFP) are an increasing issue in orthopedics. Current classification systems (CS) are mostly CT-based and complex and offer only moderate to substantial inter-rater reliability (interRR) and intra-rater reliability (intraRR). MRI is thus gaining importance as a complement. This study aimed to develop a simple and reliable CT- and MRI-based CS for OFP.
A structured iterative procedure was conducted to reach a consensus among German-speaking spinal and pelvic trauma experts over 5 years. As a result, the proposed OF-Pelvis CS was developed. To assess its reliability, 28 experienced trauma and orthopedic surgeons categorized 25 anonymized cases using X-ray, CT, and MRI scans twice via online surveys. A period of 4 weeks separated the completion of the first from the second survey, and the cases were presented in an altered order. While 13 of the raters were also involved in developing the CS (developing raters (DR)), 15 user raters (UR) were not deeply involved in the development process. To assess the interRR of the OF-Pelvis categories, Fleiss' kappa (κ) was calculated for each survey. The intraRR for both surveys was calculated for each rater using Kendall's tau (τ). The presence of a modifier was calculated with κ for interRR and Cohen's kappa (κ) for intraRR.
The OF-Pelvis consists of five subgroups and three modifiers. Instability increases from subgroups 1 (OF1) to 5 (OF5) and by a given modifier. The three modifiers can be assigned alone or in combination. In both surveys, the interRR for subgroups was substantial: κ = 0.764 (Survey 1) and κ = 0.790 (Survey 2). The interRR of the DR and UR was nearly on par (κ Survey 1/Survey 2: DR 0.776/0.813; UR 0.748/0.766). The agreement for each of the five subgroups was also strong (κ min.-max. Survey 1/Survey 2: 0.708-0.827/0.747-0.852). The existence of at least one modifier was rated with substantial agreement (κ Survey 1/Survey 2: 0.646/0.629). The intraRR for subgroups showed almost perfect agreement (τ = 0.894, DR: τ = 0.901, UR: τ = 0.889). The modifier had an intraRR of κ = 0.684 (DR: κ = 0.723, UR: κ = 0.651), which is also considered substantial.
The OF-Pelvis is a reliable tool to categorize OFP with substantial interRR and almost perfect intraRR. The similar reliabilities between experienced DRs and URs demonstrate that the training status of the user is not important. However, it may be a reliable basis for an indication of the treatment score.
骨盆骨质疏松性骨折（OFP）是骨科日益严重的问题。目前的分类系统（CS）大多基于 CT，较为复杂，仅具有中度至较大的观察者间可靠性（interRR）和观察者内可靠性（intraRR）。因此，MRI 作为一种补充手段变得越来越重要。本研究旨在开发一种简单可靠的基于 CT 和 MRI 的 OFP 分类系统。
通过结构化的迭代过程，德国脊柱和骨盆创伤专家在 5 年内达成共识。由此提出了 OF-Pelvis CS。为了评估其可靠性，28 名经验丰富的创伤和骨科外科医生使用 X 射线、CT 和 MRI 扫描对 25 个匿名病例进行了两次分类，两次分类均通过在线调查进行。两次完成调查的时间间隔为 4 周，且病例的呈现顺序有所改变。其中 13 名评估者参与了 CS 的开发（开发评估者（DR）），而 15 名用户评估者（UR）则未深入参与开发过程。为了评估 OF-Pelvis 类别的 interRR，计算了每个调查的 Fleiss' kappa（κ）。对于每个评估者，使用 Kendall's tau（τ）计算了两次调查的 intraRR。使用κ计算 interRR 的修饰符和 Cohen's kappa（κ）计算 intraRR 的修饰符。
OFP 由五个亚组和三个修饰符组成。不稳定性从亚组 1（OF1）到亚组 5（OF5）以及给定的修饰符增加。三个修饰符可以单独或组合使用。在两次调查中，亚组的 interRR 均为中度：κ=0.764（调查 1）和 κ=0.790（调查 2）。DR 和 UR 的 interRR 几乎相同（κ 调查 1/调查 2：DR 0.776/0.813；UR 0.748/0.766）。五个亚组的评估结果也具有很强的一致性（κ 最小值-最大值 调查 1/调查 2：0.708-0.827/0.747-0.852）。至少存在一个修饰符的情况被评为具有中度一致性（κ 调查 1/调查 2：0.646/0.629）。亚组的 intraRR 显示出几乎完美的一致性（τ=0.894，DR：τ=0.901，UR：τ=0.889）。修饰符的 intraRR 为 κ=0.684（DR：κ=0.723，UR：κ=0.651），这也被认为是中度的。
OFP 是一种可靠的工具，可对 OFP 进行分类，具有中度的 interRR 和几乎完美的 intraRR。经验丰富的 DR 和 UR 之间相似的可靠性表明，用户的培训状况并不重要。但是，它可能是治疗评分的可靠依据。
