Cui Lukuan, Liu Hao, Wang Jiangjing, Fan Huanhuan, Wang Dapeng, Wang Shuhui, Song Chi
Department of Bone and Soft Tissue Oncology, Cangzhou Hospital of Integrated TCM-WM·Hebei, Cangzhou Hebei, 061000, P. R. China.
Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research, Cangzhou Hebei, 061000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Apr 15;37(4):417-422. doi: 10.7507/1002-1892.202211117.
To validate the effectiveness of a novel comprehensive classification for intertrochanteric fracture (ITF).
The study included 616 patients with ITF, including 279 males (45.29%) and 337 females (54.71%); the age ranged from 23 to 100 years, with an average of 72.5 years. Two orthopaedic residents (observers Ⅰ and Ⅱ) and two senior orthopaedic surgeons (observers Ⅲ and Ⅳ) were selected to classify the CT imaging data of 616 patients in a random order by using the AO/Orthopaedic Trauma Association (AO/OTA) classification of 1996/2007 edition, the AO/OTA classification of 2018 edition, and the novel comprehensive classification method at an interval of 1 month. Kappa consistency test was used to evaluate the intra-observer and inter-observer consistency of the three ITF classification systems.
The inter-observer consistency of the three classification systems evaluated by 4 observers twice showed that the 3 classification systems had strong inter-observer consistency. Among them, the value of the novel comprehensive classification was higher than that of the AO/OTA classification of 1996/2007 edition and 2018 edition, and the experience of observers had a certain impact on the classification results, and the inter-observer consistency of orthopaedic residents was slightly better than that of senior orthopaedic surgeons. The intra-observer consistency of two evaluations of three classification systems by 4 observers showed that the consistency of the novel comprehensive classification was better for the other 3 observers, except that the consistency of observer Ⅳ in the AO/OTA classification of 2018 version was slightly higher than that of the novel comprehensive classification. The results showed that the novel comprehensive classification has higher repeatability, and the intra-observer consistency of senior orthopaedic surgeons was better than that of orthopaedic residents.
The novel comprehensive classification system has good intra- and inter-observer consistency, and has high validity in the classification of CT images of ITF patients; the experience of observers has a certain impact on the results of the three classification systems, and those with more experiences have higher intra-observer consistency.
验证一种新型粗隆间骨折（ITF）综合分类方法的有效性。
本研究纳入616例ITF患者，其中男性279例（45.29%），女性337例（54.71%）；年龄范围为23至100岁，平均72.5岁。选取两名骨科住院医师（观察者Ⅰ和Ⅱ）和两名骨科高级医师（观察者Ⅲ和Ⅳ），采用1996/2007版AO/骨科创伤协会（AO/OTA）分类法、2018版AO/OTA分类法及新型综合分类法，每隔1个月对616例患者的CT影像数据进行随机排序分类。采用Kappa一致性检验评估三种ITF分类系统的观察者内及观察者间一致性。
4名观察者对三种分类系统进行两次评估的观察者间一致性显示，三种分类系统具有较强的观察者间一致性。其中，新型综合分类法的κ值高于1996/2007版和2018版AO/OTA分类法，观察者的经验对分类结果有一定影响，骨科住院医师的观察者间一致性略优于骨科高级医师。4名观察者对三种分类系统两次评估的观察者内一致性显示，除观察者Ⅳ在2018版AO/OTA分类法中的一致性略高于新型综合分类法外，新型综合分类法在其他3名观察者中一致性更好。结果表明，新型综合分类法具有较高的重复性，骨科高级医师的观察者内一致性优于骨科住院医师。
新型综合分类系统具有良好的观察者内及观察者间一致性，在ITF患者CT图像分类中具有较高的有效性；观察者的经验对三种分类系统的结果有一定影响，经验更丰富者观察者内一致性更高。
