Mitsuzawa Sadaki, Takeuchi Hisataka, Ijiri Kenta, Furusho Yuya, Yamashita Shinnosuke, Tsukamoto Yoshihiro, Ota Satoshi, Onishi Eijiro, Yasuda Tadashi
Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
J Orthop Surg Res. 2025 Jan 7;20(1):18. doi: 10.1186/s13018-024-05423-2.
Although the Neer and AO/OTA classifications have been widely accepted, observer reliability studies of these two classifications have questioned their reliability and reproducibility to date. We developed an entirely new classification, the Mitsuzawa classification, for dislocated and displaced proximal humeral fractures and tested all three classifications for their intra- and interobserver reliability.
Two experienced shoulder surgeons and two orthopedic residents independently evaluated the Xray (xR) values of 100 proximal humeral fractures (PHFs). The inclusion criteria for PHFs were (1) fracture-dislocation of the glenohumeral joint, (2) severely displaced fracture that required arthroplasty, such as hemi-arthroplasty or reverse shoulder arthroplasty, and (3) age > 18 years. Four reviewers classified all 100 fractures according to the Neer, AO/OTA, and Mitsuzawa classifications on two occasions. The intraobserver reliability was calculated using a Cohen κ statistic, while the interobserver reliability was calculated using a Fleiss κ statistic.
The average intraobserver agreements for the Neer, AO/OTA, and Mitsuzawa classifications were 0.57 (moderate), 0.67 (substantial), and 0.77 (substantial), respectively. The average interobserver agreements for the Neer, AO/OTA, and Mitsuzawa classifications were 0.49 (moderate), 0.56 (moderate), and 0.73 (substantial), respectively. The most common fracture type in each classification was an anterior dislocated fracture with a greater tuberosity fragment, which corresponded to A3a (57 cases) in the Mitsuzawa classification.
The Mitsuzawa classification of PHF incorporates different perspectives regarding glenohumeral compatibility, assessment before and after shoulder dislocation reduction, and the degree of displacement of the proximal stump of the humeral shaft. Compared with the Neer and AO/OTA classifications, our new classification system adopted a user-friendly flowchart format and provided satisfactory intra- and interobserver reliability.
Level IV.
尽管Neer分类法和AO/OTA分类法已被广泛接受，但迄今为止，针对这两种分类法的观察者可靠性研究对其可靠性和可重复性提出了质疑。我们针对肱骨头近端骨折脱位和移位情况开发了一种全新的分类法——光泽分类法，并对这三种分类法的观察者内和观察者间可靠性进行了测试。
两名经验丰富的肩部外科医生和两名骨科住院医师独立评估了100例肱骨头近端骨折（PHF）的X线（XR）值。PHF的纳入标准为：（1）盂肱关节骨折脱位；（2）严重移位骨折，需要进行关节成形术，如半关节成形术或反肩关节成形术；（3）年龄>18岁。四名评估者分两次根据Neer、AO/OTA和光泽分类法对所有100例骨折进行分类。观察者内可靠性采用Cohen κ统计量计算，观察者间可靠性采用Fleiss κ统计量计算。
Neer、AO/OTA和光泽分类法的平均观察者内一致性分别为0.57（中等）、0.67（高度）和0.77（高度）。Neer、AO/OTA和光泽分类法的平均观察者间一致性分别为0.49（中等）、0.56（中等）和0.73（高度）。每种分类法中最常见的骨折类型是伴有大结节骨折块的前脱位骨折，这与光泽分类法中的A3a型（57例）相对应。
肱骨头近端骨折的光泽分类法纳入了关于盂肱关节相容性、肩关节脱位复位前后评估以及肱骨干近端移位程度的不同观点。与Neer和AO/OTA分类法相比，我们的新分类系统采用了用户友好的流程图形式，并提供了令人满意的观察者内和观察者间可靠性。
四级。
