Martin J S, Marsh J L, Bonar S K, DeCoster T A, Found E M, Brandser E A
University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
J Orthop Trauma. 1997 Oct;11(7):477-83. doi: 10.1097/00005131-199710000-00004.
The purpose of this study was to assess the interobserver reliability and intraobserver reproducibility of the AO/ASIF and Rüedi and Allgöwer classifications for fractures of the distal tibia, and to determine the benefit of a computed tomography (CT) scan and experience on observer agreement for several fracture characteristics, including classification.
The radiographs of forty-three fractures of the distal tibia, fourteen of which had CT scans, were assessed by groups of experienced and less-experienced observers. Each case was classified according to the AO/ASIF and Rüedi and Allgöwer systems. Several other fracture characteristics also were assessed. The kappa coefficient of agreement was calculated and used to compare the interobserver reliability and intraobserver reproducibility of the classification systems and to determine the benefit of experience and CT scans. The intraclass correlation coefficient was used to assess noncategoric data.
Interobserver and intraobserver agreements were good when classifying fractures into AO/ASIF types and significantly better than that for the Rüedi and Allgöwer system. However, agreement was poor when classifying the fractures into AO/ASIF groups. For most assessments, the experienced group tended to have higher levels of interobserver agreement, but not intraobserver agreement. Viewing the CT scans improved agreement on the percentage of articular surface involved, but it did not improve interobserver reliability or intraobserver reproducibility for either of the classification systems.
The AO/ASIF classification for fractures of the distal tibia has good observer agreement at the type level, but poor agreement at the group level. Experience tends to improve interobserver agreement, but not intraobserver agreement. Viewing CT scans does not improve agreement on classification, but it tends to improve agreement on articular surface involvement.
本研究旨在评估AO/ASIF分类法以及Rüedi和Allgöwer分类法在胫骨远端骨折中的观察者间可靠性和观察者内可重复性，并确定计算机断层扫描（CT）以及观察者经验对包括骨折分类在内的多个骨折特征一致性的影响。
由经验丰富和经验较少的观察者小组对43例胫骨远端骨折的X线片进行评估，其中14例有CT扫描。每例病例均按照AO/ASIF和Rüedi及Allgöwer系统进行分类。还评估了其他几个骨折特征。计算一致性kappa系数，用于比较分类系统的观察者间可靠性和观察者内可重复性，并确定经验和CT扫描的影响。组内相关系数用于评估非分类数据。
将骨折分为AO/ASIF类型时，观察者间和观察者内的一致性良好，且显著优于Rüedi和Allgöwer系统。然而，将骨折分为AO/ASIF组时，一致性较差。对于大多数评估，经验丰富的小组观察者间一致性水平往往较高，但观察者内一致性并非如此。查看CT扫描可提高对关节面受累百分比的一致性，但对于任何一种分类系统，均未提高观察者间可靠性或观察者内可重复性。
AO/ASIF分类法在胫骨远端骨折的类型层面观察者一致性良好，但在组层面一致性较差。经验往往会提高观察者间一致性，但不会提高观察者内一致性。查看CT扫描不会提高分类的一致性，但往往会提高关节面受累情况的一致性。
