Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China; Capital Medical University, Beijing 100020, China.
Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
Knee. 2022 Mar;35:149-156. doi: 10.1016/j.knee.2022.03.002. Epub 2022 Mar 18.
Ten-segment classification provides a different approach to the evaluation of tibial plateau fractures. The purpose of this study was to assess the intra- and inter-observer reliability of three widely used classification systems (Schatzker, Arbeitsgemeinschaft für Osteosynthesefragen (AO/OTA), and the updated three-column concept (uTCC)) with ten-segment classification in two-dimensional computed tomography (2D-CT) and three-dimensional computed tomography (3D-CT).
Ninety 2D-CT and 3D-CT scans of patients with tibial plateau fractures were included in this retrospective cohort study. The included data were independently classified by six observers of different years of seniority and were independently observed and classified again after eight weeks. Inter-observer and intra-observer reliability of the four fracture classifications made by the six observers was analyzed using the kappa statistic. Kappa values were interpreted according to the categorical rating by Landis and Koch.
When the inter-observer reliability was based on 2D-CT/3D-CT analysis, the mean Kappa values for the Schatzker, AO/OTA, uTCC, and ten-segment classification were 0.64/0.66, 0.56/0.59, 0.53/0.65, and 0.60/0.73, respectively. When intra-observer reliability was based on 2D-CT/3D-CT, the mean Kappa values for the Schatzker, AO/OTA, uTCC, and ten-segment classification were 0.68/0.83, 0.69/0.83, 0.74/0.85, and 0.80/0.91, respectively.
The use of 3D-CT is important for the reliable diagnosis and recognition of tibial plateau fracture features compared to 2D-CT. When using 3D-CT, ten-segment classification showed high intra- and inter-observer agreement.
十段分类法为胫骨平台骨折的评估提供了一种不同的方法。本研究的目的是评估三种广泛使用的分类系统（Schatzker、 Arbeitsgemeinschaft für Osteosynthesefragen（AO/OTA）和更新的三柱概念（uTCC））在二维计算机断层扫描（2D-CT）和三维计算机断层扫描（3D-CT）中的内-间观察者可靠性。
本回顾性队列研究纳入了 90 例胫骨平台骨折患者的 2D-CT 和 3D-CT 扫描。纳入的数据由 6 名不同年资的观察者独立分类，并在 8 周后再次独立观察和分类。使用kappa 统计分析 6 名观察者对 4 种骨折分类的内-间观察者可靠性。kappa 值根据 Landis 和 Koch 的分类进行解释。
当基于 2D-CT/3D-CT 分析的间观察者可靠性时，Schatzker、AO/OTA、uTCC 和十段分类的平均 kappa 值分别为 0.64/0.66、0.56/0.59、0.53/0.65 和 0.60/0.73。当基于 2D-CT/3D-CT 的内观察者可靠性时，Schatzker、AO/OTA、uTCC 和十段分类的平均 kappa 值分别为 0.68/0.83、0.69/0.83、0.74/0.85 和 0.80/0.91。
与 2D-CT 相比，3D-CT 对于可靠诊断和识别胫骨平台骨折特征非常重要。使用 3D-CT 时，十段分类具有较高的内-间观察者一致性。
