天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (3): 274-277.doi: 10.11958/20160045

• 专题研究-骨疾病 • 上一篇    下一篇

股骨转子间骨折分型诊断可靠性研究

李万强， 吴斗 ， 郑艮强 ， 马晓龙 ， 刘强   

  1. 山西医科大学附属大医院
  • 收稿日期:2016-02-01 修回日期:2016-02-04 出版日期:2016-03-15 发布日期:2016-03-15
  • 通讯作者: 刘强 E-mail:76006149@qq.com
  • 作者简介:李万强（1987）， 男， 硕士在读， 主要从事骨与关节损伤研究

A study of the diagnostic reliability of intertochanteric fracture classification

LI Wanqiang, WU Dou, ZHENG Genqiang, MA Xiaolong, LIU Qiang   

  • Received:2016-02-01 Revised:2016-02-04 Published:2016-03-15 Online:2016-03-15
  • Contact: LIU Qiang E-mail:76006149@qq.com

PDF (PC)

4182

摘要： 目的 比较股骨转子间骨折内固定研究协会AO 分型及Evans-Jensen分型在X线片与三维CT重建影像下诊断结果的可靠性，探讨三维CT的优势。方法 由3名骨科医生回顾性分析我院具有完整X线和CT三维重建检查影像学资料的54例老年股骨转子间骨折患者，分别在X线片和三维CT影像下进行AO分型和Evans-Jensen分型。应用一致性检验评价同一医生在不同影像方法下和不同医生在同一影像方法下两种分型结果的一致性。结果 采用X线片进行骨折AO分型和Evans-Jensen分型3名医生间kappa值分别为0.597（0.547~0.653）和0.571（0.539~0.600），中度一致性；而采用三维CT进行AO分型kappa值降低为0.411（0.366~0.455），中度一致性，Evans-Jensen分型kappa值升高为0.704（0.671~0.737），高度一致性。各自分别通过X线片和三维CT进行骨折AO和Evans-Jensen分型kappa值为0.464（0.406~0.579），中度一致性和0.191（0.160~0.233），一致性很弱。结论 基于X线片的AO分型和Evans-Jensen分型均有中度的组间一致性，而采用三维CT不能提高AO分型的一致性，且不适用于Evans-Jensen分型。

关键词: 体层摄影术, X 线计算机, 成像, 三维, X 线胶片, 诊断, AO 分型, Evans-Jensen 分型, 股骨转子间骨折

Abstract: Objective To compare the diagnostic reliability of intertochanteric fracture AO and Evans-Jensen classifications in X ray film and three-dimensional CT reconstruction images and explore advantage of the three-dimensional CT. Methods A retrospective study was performed to evaluate 54 intertochanteric fractures．Thress orthopaedic surgeonswere asked to make assessment of fracture classifications using X ray film and the three-dimensional CT images. Agreement test was performed to evaluate interobserver and intraobserver reliability for fracture classification. Results When X ray film was used, interobserver reliability mean kappa value between three surgeons for AO and Evans-Jensen classifications were 0.597 (0.547-0.653) and 0.571 (0.539-0.600), medium consistency. While using three-dimensional CT to AO classification lower kappa value was 0.411 (0.366-0.455), medium consistency, Evans - Jensen classification kappa value was 0.704 (0.671-0.737), highly consistency. Each surgeon respectively through the X ray film and three-dimensional CT the AO and Evans-Jensen classification mean kappa value were 0.464 (0.406-0.579), medium consistency and 0.191 (0.160-0.233), weak consistency. Conclusion Both classifications based on X ray film showed moderate consistency , using three-dimensional CT does not improve the consistency of AO classification. And the three-dimensional CT does not apply to Evans-Jensen classification.