增加CT对桡骨远端骨折分型的可靠性及可重复性评价  

Evaluation of the reliability and repeatability of the classification system of distal radius fractures and the effect of increasing CT on the evaluation results

作　　者：张峻[1,2] 赵建民[1] 姚晓克[3] 吉浩宇[1] 越瑞祥[4] Zhang Jun;Zhao Jianmin;Yao Xiaoke;Ji Ha-oyu;Yue Ruixiang(Department of Orthopaedics,the affiliated hospital of Innermongolia medical university,Hohhot 010000,China;Department of Orthopaedics,the First Medical Center of the General Hospital of the People's Liberation Army,Beijing 100853,China;Department of Orthopedics,Chengdu First People's Hospital,Chengdu 610000,China;Department of General Surgery,Wu Lan Cha Bu Central Hospital,Jin-ing 012000,China)

机构地区：[1]内蒙古医科大学附属医院骨科,呼和浩特010000 [2]解放军总医院第一医学中心骨科,北京100853 [3]成都市第一人民医院骨科,成都610000 [4]乌兰察布市中心医院普通外科,集宁012000

出　　处：《中华老年骨科与康复电子杂志》2024年第5期264-272,共9页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：内蒙古自治区高等学校科学研究项目重点项目(NJZZ21034);内蒙古自治区卫生健康委医疗卫生科技计划项目(20210601);四川省卫生健康委员会医学科技项目(21PJ138)。

摘　　要：目的对桡骨远端骨折的主要分型系统进行一致性检验,为临床医生选择分型系统提供重要指导。方法2014年1月1日至2018年6月31日,回顾性研究我院220例桡骨远端骨折患者。三名观察者随机选择并评估了50例患者在T1、T2、T3和T4四个不同时间节点的AO/OTA、Frykman、Fernández和Universal分型的放射学数据。时间节点T1和T2用于基于DR确定每个观察者的观察者内重复性。时间节点T3和T4用于基于DR和CT+2D确定每个观察者的观察者间重复性。Cohen’s kappa用于计算一致性。结果基于DR和DR+CT的观察者间信度Kappa值:AO/OTA分型0.14 vs.0.32;AO/OTA分组0.18 vs.0.35;Frykman 0.34 vs.0.29;Fernández 0.31vs.0.22;Universal 0.27 vs.0.30。观察者内重复性Kappa值:AO/OTA分型0.47 vs.0.67;AO/OTA分组0.48 vs.0.67;Frykman 0.70 vs.0.66;Fernández 0.59 vs.0.58;Universal 0.60 vs.0.59。结论CT+2D检查的增加可能不会改善Frykman分型、Fernández分型和Universal分型的观察者一致性结果。AO/OTA分型和AO/OTA分组的观察者一致性结果可以得到改善。Objective Consistency testing is performed on the main classification system of distal radius fractures,which provides an important guidance for clinicians to choose the classification system.Methods A retrospective study was performed.From January 1,2014 to June 31,2018,220 patients with distal radius fractures were included in our hospital.Three observers randomly selected and evaluated the ra-diography data of 50 cases by AO/OTA,Frykman,Fernández and Universal at four different time nodes of T1,T2,T3 and T4.Time nodes T1 and T2 were used to determine the intra-observer repeatability of each ob-server based on DR.Time nodes T3 and T4 were used to determine the intra-observer repeatability of each observer based on DR and CT+2D.Cohen’s kappa was used to calculate consistency.Results Inter-observ-er reliability Kappa values based on DR and DR+CT:AO/OTA classification 0.14 vs.0.32;AO/OTA group-ing 0.18 vs.0.35;Frykman 0.34 vs.0.29;Fernández 0.31 vs.0.22;Universal 0.27 vs.0.30.The intra-observ-er repeatability Kappa value:AO/OTA typing 0.47 vs.0.67;AO/OTA grouping 0.48 vs.0.67;Frykman 0.70 vs.0.66;Fernández 0.59 vs.0.58;Universal 0.60 vs.0.59.Conclusion The increase of CT+2D examina-tion may not improve the observer consistency results of Frykman classification,Fernández classification,and Universal classification.The observer consistency results of AO/OTA classification and AO/OTA group-ing can be improved.Based on previous study and our research,there is currently no gold standard for the classification of distal radius fractures or the recommended classification.

关 键 词：桡骨远端骨折 骨折 分型 

分 类 号：R687.3[医药卫生—骨科学]