2D-CT与3D-CT显像对跟骨关节内骨折评价的信度和效度分析

Reliability and validity of 2D-CT and 3D-CT imaging in evaluation of calcaneus intraarticular fracture

目的通过比较2D-CT与3D-CT显像对跟骨距下关节面损伤评价的信度和效度,探讨CT检查的诊断优势。方法 4名骨科高年资医师回顾性分析2010年1月～2011年6月间收治的76例跟骨距下关节面损伤的病例,分别使用2D-CT和3D-CT影像对骨折分型和骨折特征做出判断,以一致性检验分析骨折分型判断结果的评定者间信度和评定者自身信度,分析骨折特征判断结果的标准效度(手术记录描述作为金标准),并用McNemar检验比较2D-和3D-CT判断结果与金标准的差异。结果 3D-CT对跟骨距下关节面损伤分型的判断结果的信度与2D-CT无明显差异,对骨折特征的判断结果与金标准的一致性则显著高于2D-CT(P=0.005)。结论使用3D-CT检查能够提高对跟骨距下关节面损伤评价的可靠性和准确性,可更好指导手术方案的制订。

Objective To make comparison between the reliability and validity of both 2D-CT and 3D-CT imaging in evaluation of calcaneus intraarticular fracture,and to discuss the diagnostic superiority of CT examination.Methods Four senior doctors in the department of orthopaedics analyzed retrospectively 76 cases of calcaneus subtalar joint surface injury who were hospitalized from January 2010 to June 2011.2D-CT and 3D-CT imaging were respectively used to judge the fracture type and characteristics.Consistency check was used to analyze the raters＇ internal and external reliability in the judgment of fracture type,and also to analyze the standard validity of the facture judgment results（the operation record description was used as the gold standard）.The differences between the 2D-CT and 3D-CT judgment results and the gold standard were compared by McNemar test.Results There was no significant difference between the typing results of calcaneus subtalar joint surface injury by 3D-CT examination and 2D-CT examination.The consistency of 3D-CT fracture judgment results with the gold standard was significantly higher than that of 2D-CT results（P=0.005）.Conclusion The 3D-CT examination can increase the reliability and accuracy of the evaluation of calcaneus subtalar joint surface injury,and is helpful to guide the determination of operation schedule.