Brage M E, Rockett M, Vraney R, Anderson R, Toledano A
University of Chicago Hospitals and Clinics, Illinois 60637, USA.
Foot Ankle Int. 1998 Aug;19(8):555-62. doi: 10.1177/107110079801900809.
Our hypothesis was that malleolar ankle fractures could be classified with two radiographic views as reliably as with three views. Four different observers independently evaluated 99 sets of ankle radiographs. The examiners classified the ankle fractures by using both the Lauge-Hansen and Danis-Weber systems. The interobserver and intraobserver variations were analyzed by kappa statistics. With regard to intraexaminer reliability, the examiners demonstrated excellent accord in classifying the fractures in the Danis-Weber system with either three views or two views. The kappa values were comparable. In the Lauge-Hansen system, three examiners demonstrated excellent accord and one examiner demonstrated good accord in classifying the fractures. Similar kappa values were generated when examiners classified fractures with either three views or two views. With regard to interexaminer reliability, good to excellent accord was demonstrated overall among the four examiners when they used the Danis-Weber system with either three views or two views. The examiners were in good agreement when they used the Lauge-Hansen system. Similar kappa values were generated whether the examiners used three views or two views. Three radiographic views are usually ordered for evaluation of an acute ankle injury. Previous studies have shown that only two views are needed for diagnosis of a malleolar ankle fracture. This study demonstrates that malleolar ankle fractures can be classified with two views, lateral or mortise, with a reliability as good as that achieved with three views. The best agreement is achieved with lateral and mortise views.
我们的假设是，踝关节骨折通过两张X线片分类与通过三张X线片分类一样可靠。四位不同的观察者独立评估了99组踝关节X线片。检查者使用Lauge-Hansen和Danis-Weber系统对踝关节骨折进行分类。通过kappa统计分析观察者间和观察者内的差异。关于检查者内的可靠性，检查者在使用Danis-Weber系统通过三张或两张X线片对骨折进行分类时表现出高度一致性。kappa值相当。在Lauge-Hansen系统中，三位检查者在对骨折进行分类时表现出高度一致性，一位检查者表现出良好的一致性。当检查者通过三张或两张X线片对骨折进行分类时，产生了相似的kappa值。关于检查者间的可靠性，当四位检查者使用Danis-Weber系统通过三张或两张X线片时，总体上表现出良好到高度的一致性。当检查者使用Lauge-Hansen系统时，他们的意见高度一致。无论检查者使用三张还是两张X线片，都会产生相似的kappa值。通常会要求拍摄三张X线片来评估急性踝关节损伤。先前的研究表明，诊断踝关节骨折仅需要两张X线片。本研究表明，踝关节骨折通过侧位或斜位两张X线片分类，其可靠性与通过三张X线片分类相同。通过侧位和斜位片可获得最佳一致性。
