Andersen D J, Blair W F, Steyers C M, Adams B D, el-Khouri G Y, Brandser E A
Department of Orthopaedics, University of Iowa, Iowa City, USA.
J Hand Surg Am. 1996 Jul;21(4):574-82. doi: 10.1016/s0363-5023(96)80006-2.
The Frykman, Melone, Mayo, and AO classification systems for distal radius fractures were evaluated for interobserver reliability and intraobserver reproducibility in a clinical setting using initial plain radiographs. Two attending orthopedic hand surgeons and two attending radiologists classified 55 sets of distal radius fractures. kappa-statistics were used to establish a relative level of agreement between observers for the two readings and between separate readings by the same observer. Interobserver agreement was rated as moderate for the Mayo classification and fair for the Frykman, Melone, and AO classifications. Intraobserver agreement was substantial for only one of four observers for each of the Frykman, Melone, and Mayo, while the remaining three observers achieved only fair to moderate reproducibility. Intraobserver agreement for the AO classification was fair for all four of the observers. Neither interobserver or intraobserver agreement was affected by combining similar subclasses in the Melone classification or by reducing the number of categories in the AO system from 27 to 9. However, further reducing the AO system to its three main types brought agreement to the "substantial" level. No difference was found in interobserver agreement between the first and second readings or in interobserver or intraobserver agreement between orthopedic hand surgeons and radiologists. Understanding the limitations of fracture classifications based solely on plain radiographs can help avoid undue reliance on them. Given the low degree of interobserver and intraobserver agreement for each of the distal radius fracture classifications in this study, their use as the sole means for determining the direction of treatment or for the direct comparison of results among different studies is not warranted.
在临床环境中，使用初始X线平片对桡骨远端骨折的Frykman、Melone、Mayo和AO分类系统进行了观察者间可靠性和观察者内可重复性评估。两位骨科手外科主治医生和两位放射科主治医生对55组桡骨远端骨折进行了分类。kappa统计用于确定两次读数之间观察者之间以及同一观察者不同读数之间的相对一致程度。观察者间一致性对于Mayo分类评为中等，对于Frykman、Melone和AO分类评为一般。对于Frykman、Melone和Mayo分类，四位观察者中只有一位观察者内一致性较高，而其余三位观察者仅达到一般至中等的可重复性。对于AO分类，四位观察者的观察者内一致性均为一般。在Melone分类中合并相似亚类或在AO系统中将类别数量从27个减少到9个，均未影响观察者间或观察者内一致性。然而，将AO系统进一步简化为其三种主要类型可使一致性达到“较高”水平。第一次和第二次读数之间的观察者间一致性以及骨科手外科医生和放射科医生之间的观察者间或观察者内一致性均未发现差异。了解仅基于X线平片的骨折分类的局限性有助于避免过度依赖它们。鉴于本研究中每种桡骨远端骨折分类的观察者间和观察者内一致性程度较低，将其用作确定治疗方向或直接比较不同研究结果的唯一手段是不合理的。
