Chan P S, Klimkiewicz J J, Luchetti W T, Esterhai J L, Kneeland J B, Dalinka M K, Heppenstall R B
Department of Orthopaedic Surgery, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
J Orthop Trauma. 1997 Oct;11(7):484-9. doi: 10.1097/00005131-199710000-00005.
To evaluate the interobserver and intraobserver agreement for both treatment plan and fracture classification of tibial plateau fractures using plain films alone and with computed tomography (CT) scans.
Prospective study to assess the impact of an advanced radiologic study on the agreement of treatment plan and fracture classification of tibial plateau fractures.
SETTING/PARTICIPANTS: Two orthopaedic traumatologists, two orthopaedic residents, and two skeletal radiologists were presented with twenty-one cases of tibial plateau fractures imaged with plain films and with CT scans.
Agreement was measured using kappa coefficients.
Using plain films alone, the mean interobserver kappa coefficient for classification was 0.62, which decreased to 0.61 after addition of CT scans. Using plain films alone for formulating a treatment plan, the mean interobserver kappa coefficient was 0.58, which increased to 0.71 after addition of CT scans. The mean intraobserver kappa coefficient for fracture classification using plain films was 0.70, which increased to 0.80 with addition of CT scans. The mean intraobserver kappa coefficient for treatment plan based on plain films alone was 0.62, which increased to 0.82 after addition of CT scans. Class was changed in an average of 12 percent of cases after addition of CT scans. Treatment plan was changed an average of 26 percent of the time after addition of CT scans.
Addition of CT scans to plain roentgenograms increases the interobserver and intraobserver agreement on treatment plan.
评估仅使用平片以及联合计算机断层扫描（CT）对胫骨平台骨折进行治疗方案制定和骨折分类时，观察者间及观察者内的一致性。
一项前瞻性研究，旨在评估一项先进的影像学检查对胫骨平台骨折治疗方案制定和骨折分类一致性的影响。
地点/参与者：向两名骨科创伤专家、两名骨科住院医师和两名骨骼放射科医生展示了21例胫骨平台骨折的平片和CT扫描影像。
使用kappa系数来衡量一致性。
仅使用平片时，分类的观察者间平均kappa系数为0.62，添加CT扫描后降至0.61。仅使用平片制定治疗方案时，观察者间平均kappa系数为0.58，添加CT扫描后增至0.71。仅使用平片进行骨折分类时，观察者内平均kappa系数为0.70，添加CT扫描后增至0.80。仅基于平片制定治疗方案时，观察者内平均kappa系数为0.62，添加CT扫描后增至0.82。添加CT扫描后，平均12%的病例分类发生了改变。添加CT扫描后，治疗方案平均有26%的时间发生了改变。
在平片基础上增加CT扫描可提高观察者间及观察者内对治疗方案的一致性。
