髋关节置换术后假体周围骨折3种分型的可信度和可重复性研究

Reliability and Reproducibility of Three Types of Periprosthetic Fractures after Hip Replacement

目的探讨人工髋关节置换术后假体周围骨折UCS分型、Vancouver分型和Johansson分型的可信度和可重复性.方法选取5名骨科医师,根据临床及影像学资料,分别采用这3种分型方法对40例髋关节置换术后假体周围骨折患者进行分型.8周后,打乱资料顺序再次进行分型,通过平均Kappa系数的K值评估其可信度和可重复性.结果观察者间的可信度:Johansson分型的平均K值为0.512(0.362~0.622),属于中度可信;Vancouver分型的平均K值为0.759(0.690~0.885),属于基本可信;UCS分型的平均K值为0.784(0.654~0.829),属于基本可信.可重复性分析:Johansson分型的平均K值为0.510(0.396~0.586),属于中度可信;Vancouver分型的平均K值为0.776(0.691~0.962),属于基本可信;UCS分型的平均K值为0.804(0.720~0.830),属于完全可信.结论Vancouver分型和UCS分型在可信度和可重复性上明显优于Johansson分型,而UCS分型作为Vancouver分型的补充,弥补了传统分型的不足,更适合指导髋关节置换术后假体周围骨折的治疗,建议在临床工作中优先使用.

Objective To explore the reliability and reproducibility of UCS classification,Vancouver classif-ication and Johansson classification of periprosthetic fractures after artificial hip replacement.Method Fiveorthopedists were selected.Based on clinical and imaging data,three classification methods were used to classify40 patients with prosthetic fractures after hip replacement.After 8 weeks,the order of the data was disrupted,andthe classification was performed again.The average Kappa coefficient K value was used to evaluate the reliabilityand reproducibility.Results Credibility among observers;The average K value of the Johansson classification is0.512(0.362~0.622),which is moderately reliable,and the average K value of the Vancouver classification is0.759(0.690~0.885),which is basically credible,and the average K value of UCS classification is 0.784(0.654~0.829),which is basically credible.Reproducibility analysis;The average K value of the Johansson classification is 0.510(0.396~0.586),which is moderately credible,and the average K value of the Vancouver classification is 0.7776(0.691~0.962),which is basically credible.The average K value of UCS classification is 0.804(0.720~0.830),which is completely credible.ConclusionThe Vancouver classification and UCSclassification are significantly better than the Johansson classification in terms of reliability and reproducibility.The UCS classification as a supplement to the Johansson classification makes up for the shortcomings of thetraditional classification and is more suitable for guiding hip replacement treatment of fractures around theposterior,is recommended for clinical use.