Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile.
Department of Orthopaedic Surgery, Clinica Las Condes, Santiago, Chile; Hospital El Carmen-Dr. Luis Valentín Ferrada, Santiago, Chile.
Injury. 2022 Feb;53(2):514-518. doi: 10.1016/j.injury.2021.12.041. Epub 2021 Dec 26.
Sacral fractures treatment frequently involves both spine and pelvic trauma surgeons; therefore, a consistent communication among surgical specialists is required. We independently assessed the new AOSpine sacral fracture classification's agreement from the perspective of spine and pelvic trauma surgeons.
Complete computerized tomography (CT) scans of 80 patients with sacral fractures were selected and classified using the new AOSpine sacral classification system by six spine surgeons and three pelvic trauma surgeons. After four weeks, the 80 cases were presented and reassessed by the same raters in a new random sequence. The Kappa coefficient (κ) was used to measure the inter-and intra-observer agreement.
The inter-observer agreement considering the fracture severity types (A, B, or C) was substantial for spine surgeons (κ= 0.68 [0.63 - 0.72]) and pelvic trauma surgeons (κ= 0.74 (0.64 - 0.84). Regarding the subtypes, both groups achieved moderate agreement with κ= 0.52 (0.49 - 0.54) for spine surgeons and κ= 0.51 (0.45 - 0.57) for pelvic trauma surgeons. The intra-observer agreement considering the fracture types was substantial for spine surgeons (κ= 0.74 [0.63 - 0.75]) and almost perfect for pelvic trauma surgeons (κ= 0.84 [0.74 - 0.93]). Concerning the subtypes, both groups achieved substantial agreement with, κ= 0.61 (0.56 - 0.67) for spine surgeons and κ= 0.68 (0.62 - 0.74) for pelvic trauma surgeons.
This classification allows an adequate communication for spine surgeons and pelvic trauma surgeons at the fracture severity type, but the agreement is only moderate at the subtype level. Future prospective studies are required to evaluate whether this classification allows for treatment recommendations and establishing prognosis in patients with sacral fractures.
骶骨骨折的治疗常涉及脊柱和骨盆创伤外科医生，因此需要外科专家之间进行持续的沟通。我们从脊柱和骨盆创伤外科医生的角度独立评估了新的 AOSpine 骶骨骨折分类的一致性。
选择 80 例骶骨骨折患者的完整计算机断层扫描（CT）图像，并由 6 名脊柱外科医生和 3 名骨盆创伤外科医生使用新的 AOSpine 骶骨分类系统进行分类。四周后，以新的随机顺序由同一位评估者对 80 例进行再次评估。使用 Kappa 系数（κ）来衡量组内和组间的一致性。
考虑骨折严重程度类型（A、B 或 C）时，脊柱外科医生的组间一致性为中等（κ=0.68[0.63-0.72]），骨盆创伤外科医生的组间一致性为高度（κ=0.74[0.64-0.84]）。关于亚型，两组的一致性均为中等，脊柱外科医生的κ值为 0.52（0.49-0.54），骨盆创伤外科医生的κ值为 0.51（0.45-0.57）。考虑骨折类型时，脊柱外科医生的组内一致性为高度（κ=0.74[0.63-0.75]），骨盆创伤外科医生的组内一致性为几乎完美（κ=0.84[0.74-0.93]）。关于亚型，两组的一致性均为高度，脊柱外科医生的κ值为 0.61（0.56-0.67），骨盆创伤外科医生的κ值为 0.68（0.62-0.74）。
该分类系统允许脊柱外科医生和骨盆创伤外科医生在骨折严重程度类型方面进行充分沟通，但在亚型水平上的一致性仅为中等。需要进一步进行前瞻性研究，以评估该分类系统是否允许对骶骨骨折患者提出治疗建议和建立预后。
