基于三柱构成理念的改良髋臼骨折分型的可信度与可重复性研究

Reliability and Repeatability of the Improved Classification of Acetabular Fractures Based on the Concept of Three-column Structure

目的探索基于三柱构成理念的改良髋臼骨折分型的可信度与可重复性。方法本研究纳入2016年8月至2020年8月南京鼓楼医院高淳分院收治的108例髋臼骨折患者的临床病例资料,其中男58例,女50例;年龄18~60岁,平均(39.45±10.24)岁。由4名从事临床工作5年以上的骨科医生根据患者X线、三维CT资料对髋臼骨折进行Letournel-Judet分型以及改良髋臼骨折分型,3个月后进行第二次分型,通过一致性Kappa检验分析这两种分型方法的可信度与可重复性。结果使用改良髋臼骨折分型可以全部纳入108例髋臼骨折,而使用Letournel-Judet分型有平均7.25例无法纳入。改良髋臼骨折分型,不同医生同一时间点的可信度检验的Kappa平均值为0.891,相同医师不同时间点可重复性的Kappa值为0.938;而Letournel-Judet分型的可信度平均值为0.857,可重复性为0.897。改良髋臼骨折分型的可信度与可重复性略高于Letournel-Judet分型,同时两种分型方法的可信度与可重复性都达到优等级。结论基于三柱构成理念的改良髋臼骨折分型具有较高的可信度与可重复性,且能更好地覆盖各种髋臼骨折类型,在临床中可更好地帮助医师对髋臼骨折进行分型及制定治疗方案。

Objective To explore the reliability and repeatability of the improved classification of acetabular fractures based on the concept of three-column structure.Methods Clinical data of 108 patients with acetabular fracture admitted to Gaochun Branch of Nanjing Guou Hospital from August 2016 to August 2020 were included in this study.TheLetourne-Judet classification and modified acetabular fracture classification were performed by 4 orthopedic surgeons who had practicedfor more than 5 years according to the X-ray and 3D CT data of the patients.Three months later,the second typing was performed,and the reliability and reproducibility of the two typing methods were analyzed by consistency Kappa test.Results Using the modified acetabular fracture classification,all 108 acetabular fractures could be included.However,an average of 7.25 cases could not be included by Letournel-Judetclassification.For improved acetabular fracture classification,the Kappa mean value of credibility test by different doctors at the same time point was 0.891.The Kappa value of reproducibility at different time points for the same physician was 0.938.The average reliability of Letournel-Judet classification was 0.857.The reproducibility was 0.897.The reliability and reproducibility of the modified acetabular fracture classification were slightly higher than that of the Letournel-Judet classification,and both the reliability and reproducibility of the two methods reached excellent grade.Conclusion The improved classification of acetabular fractures based on the concept of three pillars has high reliability and repeatability and can better include all types of acetabular fractures,and can better help physicians to classify acetabular fractures and make treatment plans in clinical practice.