Pilon骨折四柱分型的可信度评价

Reliability assessment of the Four-Column classification of Pilon fractures

关键词:  Pilon骨折  分型  可信度评价

Key words:  Pilon fracture  classification  reliability assessment

摘要:

目的　研究Pilon骨折四柱分型观察者间的可信度和观察者自身的可信度，并与传统的Ruedi-Allgower分型、AO分型比较，分析四柱分型的可靠性。方法　收集2008年1月至2015年12月大连医科大学附属第一医院收治的162例Pilon骨折患者（其中5例为双侧Pilon骨折，共167例Pilon骨折）。所有 Pilon骨折随机排列，用随机数字表随机选取60例，每一例均具有完整的术前临床及影像学资料。选择6位创伤骨科医生，在分型的前一周，对这6位医生进行培训。1周之后，6位医生对60例Pilon骨折的影像学资料进行阅片，分别进行AO分型、Ruedi-Allgower分型、四柱分型。可重复性研究在8周后进行，使用相同的病例，不更换参加分型的人员，不重新进行培训。应用平均Kappa系数κ值评估观察者间可信度和观察者自身可信度。结果　观察者间的可信度：AO分型的平均κ值为0.370（范围0.254-0.485），属于轻中度可信，Ruedi-Allgower分型的平均κ值为0.344（范围0.161-0.501），属于轻中度可信，四柱分型的平均κ值为0.739（范围0.615-0.832），属于基本可信。观察者自身可信度：AO分型的平均κ值为0.383（范围0.283-0.472），属于轻中度可信，Ruedi-Allgower分型的平均κ值为0.385（范围0.229-0.582），属于轻中度可信，四柱分型的平均κ值为0.757（范围0.715-0.812），属于基本可信。结论　Pilon骨折四柱分型是一种既简单又全面的分型理论，可以弥补传统分型的不足，建议在临床工作中优先使用。

Abstract:

Objective　 To evaluate inter-observer and intra-observer reliability of Four-Column classification of Pilon fractures and compare with the traditional classifications of Ruedi-Allgower and AO to demonstrate the reliability of Four-Column classification. 　Methods　 From January 2008 to December 2015, 162 patients with Pilon fractures were treated in the first Affiliated Hospital of Dalian Medical University (including 5 cases of bilateral Pilon fractures, a total of 167 Pilon fractures). All Pilon fractures were randomly ordered with a random number table, and then we randomly selected 60 Pilon fractures. All patients had preoperative clinical and radiological data. Six orthopedists were selected and trained for the classifications. One week after training, imaging data of the 60 cases were distributed to the six orthopedists for radiological classification, including AO classification, Ruedi-Allgower classification, and Four-Column classification. Reproducibility study was performed eight weeks later using the same cases and the same orthopedists without re-training. The kappa coefficients (κ) was utilized to assess inter-observer and intra-observer reliabilities. 　Results 　The average κ value of inter-observer reliability was 0.370 (ranging 0.254-0.485) for AO classification, representing “fair agreement”; 0.344 (ranging 0.161-0.501) for Ruedi-Allgower classification, representing “fair agreement”; and 0.739 (ranging 0.615-0.832) for Four-Column classification, representing “substantial agreement”. The average κ value of intra-observer reliability was 0.383 (ranging 0.283-0.472) for AO classification, representing “fair agreement”; 0.385 (ranging 0.229-0.582) for Ruedi-Allgower classification, representing “fair agreement”; and 0.757 (ranging 0.715-0.812) for Four-Column classification, representing “substantial agreement”. Conclusion　 Four-Column classification is a simple and comprehensive classification theory, and can make up the insufficiencies in the traditional classifications. Therefore, we suggest to give priority to the use of Four-Column classification in clinical work.