摘要目的 通过比较股骨转子间传统骨折分型与三维新分型的一致性,探讨新分型的可靠性.方法 纳入2017年1月1日至2019年1月1日于首都医科大学附属北京朝阳医院住院治疗的189例股骨转子间骨折患者术前的X线片和CT影像资料,6名骨科医生作为观察者对上述患者分别采用Evans分型、Jensen分型、AO分型和新分型进行分型.1个月后将原有的189例患者的影像资料重新编号,再次用同样的方法进行分型.比较基于X线片和CT不同分型的观察者间和观察者内的卡帕(Kappa)系统. 结果 Evans分型、Jensen分型、AO分型、新分型X线片的观察者间卡帕(Kappa)值分别为0.54±0.03、0.53±0.03、0.45±0.03、0.63±0.02,CT的观察者间Kappa值分别为0.49±0.03、0.49±0.03、0.44±0.04、0.63±0.03.X线片的观察者内Kappa值分别为0.53±0.02、0.54±0.03、0.44±0.04、0.65±0.02,CT的观察者内Kappa值分别为0.52±0.03、0.52±0.03、0.41±0.02、0.64±0.03.基于X线片和CT,新分型的观察者间、观察者内Kappa值均高于Evans分型、Jensen分型和AO分型,差异有统计学意义(p＜0.05). 结论 与传统的股骨转子间骨折分型相比,新分型可靠性强.

abstractsObjective To verify the reliability of novel 3D classification of intertrochanteric fractures by comparing the consistency between conventional and novel classifications.Methods Included for the present study were the preoperative X-ray and CT images of 189 patients with intertrochanteric fracture who had been hospitalized at Department of Orthopaedics,Beijing Chao Yang Hospital,Capital Medical University from 1 January,2017 to 1 January,2019.The patients' intertrochanteric fractures were classified by 6 orthopedic surgeons independently using Evans classification,Jensen classification,AO classification and novel 3D classification,respectively.One month later,the original images of the 189 patients were renumbered and classified again in the same way.The Kappa values between observers and within observers were calculated for the classifications of intertrochanteric fractures based on X-ray and CT images.Results In Evans classification,Jensen classification,AO classification and novel 3D classification,the interobserver Kappa values of X-ray films were 0.54 ± 0.03,0.53 ± 0.03,0.45 ± 0.03 and 0.63 ± 0.02,respectively,and the interobserver Kappa values of the CT images were 0.49 ± 0.03,0.49 ± 0.03,0.44 ± 0.04 and 0.63 ± 0.03.The intraobserver Kappa values of the X-ray films were 0.53 ± 0.02,0.54 ± 0.03,0.44 ±0.04 and 0.65 ± 0.02,respectively,and the intraobserver Kappa values of the CT images were 0.52 ± 0.03,0.52 ±0.03,0.41 ±0.02 and 0.64 ±0.03.In the novel classification based on X-ray and CT images,the interobserver and intraobserver Kappa values were both significantly higher than those in Evans,Jensen and AO classifications (P ＜ 0.05).Conclusion The novel 3D classification of intertrochanteric fractures is more reliable than the conventional ones.