三维CT成像对胫骨平台骨折术前评价结果的信度与效度分析

Reliability and validity of 3D CT imaging in preoperative evaluation of tibial plateau fractures

目的通过比较使用三维CT与二维CT影像时对胫骨平台骨折分型和骨折特征术前评定结果的信度与效度，探讨三维CT的诊断优势。方法4名骨科高年资医生回顾性分析2004年9月至2006年11月间收治的21例胫骨平台骨折患者的病历，分别使用二维CT和三维CT影像对骨折分型和骨折特征做出判断，使用一致性检验来分析骨折分型判断结果的评定者问信度和评定者自身信度，和对骨折特征判断结果的标准效度（术中观察结果作为金标准），并用McNemar检验比较三维CT和二维CT判断结果与金标准的一致性差异。结果使用三维CT时，对骨折分型判断结果的评定者间信度和评定者自身信度均改善为极度一致，对骨折特征判断结果与金标准的一致性显著性高于二维CT（P=0．027）。结论使用三维CT影像能提高对胫骨平台骨折分型和特征术前评价的可靠性和准确性，三维CT对胫骨平台骨折术前评价有很高的应用价值。

Objective To compare the diagnostic values of 3D CT and 2D CT imaging for tibial plateau fractures. Methods A retrospective study was performed to evaluate 21 tibial plateau fractures. Four experienced orthopaedists were asked to make assessment of fracture classifications and characteristics using 3D CT and 2D CT images. Agreement test was performed to evaluate interobserver and intraobserver reliability for fracture classification and criteria validity for fracture characteristics （intraoperative findings were taken as the golden standard） . Furthermore, McNemar test was used to compare the agreement of 3D CT results and 2D CT results respectively with the golden standard for fracture characteristics. Results When 3D CT images were used, interobserver reliability and intraobserver reliability for fracture classification increased to ＂almost perfect agreement＂ . The agreement of golden standard with 3D CT results for fracture characteristics was significantly higher than that with 2D CT results. Conclusion Since 3D CT imaging can improve the reliability and accuracy of preoperative assessment of tibial plateau fractures, it is helpful and valuable for tibial plateau fractures.