改良髋臼骨折分型系统的可信度与可重复性评价

Evaluation of credibility and repeatability of modified acetabular fracture classification system

髋臼骨折的Letournel-Judet分型系统应用十分广泛,但仍存在分类囊括不全、分类概念混乱等不足,不能有效指导治疗.侯志勇教授基于髋臼三柱构成理念,提出了改良髋臼骨折分型系统,详细阐述了该分型的分类方法,但该分型的可信度与可重复性尚缺乏数据支撑.对此,笔者纳入河北医科大学第三医院和西安交通大学医学院附属红会医院近5年收治的影像学资料较为完备的463例患者,由4名创伤骨科医师按改良髋臼骨折分型方法阅片后分型;2个月后将原来顺序打乱再次分型,应用分型一致性Kappa检验对该改良分型进行可信度与可重复性分析,并与Letournel-Judet分型系统进行比较.结果表明,该分型的可信度与可重复性均高于Letournel-Judet分型系统,提示具有临床应用可行性.

The Letournel-Judet classification system for acetabular fractures is widely used, but there are still some shortcomings, such as incomplete classification and confusion of classification concepts, which cannot effectively guide the treatment. Professor Hou Zhiyong proposed and elaborated an improved acetabular fracture classification system based on the concept of three columns of acetabulum. However, the credibility and repeatability of the classification still lacked validation from clinical data. In this regard, the author included 463 patients with relatively complete imaging data admitted to Third Hospital of Hebei Medical University and Honghui Hospital affiliated to Xi'an Jiaotong University Medical College in the past five years. Four trauma orthopedists classified the patients according to the modified classification method of acetabular fracture. After two months, the original sequence of imaging data was disrupted and re-classified by the same trauma orthopedists. The consistency of the classification was evaluated by Kappa test and compared with Letournel-Judet classification. The results showed that credibility and repeatability of the modified classification were higher than Letournel-Judet classification, suggesting the feasibility of clinical application.