目的:锁骨远端骨折分型直接影响治疗决策。目前尚不清楚实施的分类系统是否因外科医生的背景而异。这项研究旨在比较肩关节专家和普通创伤外科医师用于锁骨外侧骨折的四种分类系统的观察者共识。
方法:由来自10家不同医院的8名经验丰富的肩关节专家和8名普通创伤外科医师分析了20例锁骨外侧骨折的X线照片,这些照片代表了完整的成人骨折类型。所有病例均根据骨科创伤协会(OTA)进行分级,Neer,Jäger/Breitner,和贡吉分类系统。为了衡量观察员协议,应用并评估了弗莱斯卡帕系数(κ)。
结果:当只提供X射线胶片时,双方达成了公平的协议。然而,当提供3D-CT扫描图像时,当OTA,Jäger/Breitner,并使用了贡吉分类系统。在通才团体中,在使用贡吉分类系统时发现了改进的一致性。就观察者间的可靠性而言,OTA,Neer,Jäger/Breitner分类系统在肩部专家之间显示出更好的一致性,而使用贡基分类系统发现的协议水平略低。对于OTA分类系统,观察者共识的平均kappa值为0.418,范围为0.446(专家组)至0.402(通才组).对于Neer分类系统,观察者共识的平均kappa值为0.368,范围为0.402(专家组)至0.390(通才组).对于Jäger/Breitner分类系统,观察者间协议的平均kappa值为0.380,范围为0.413(专家组)至0.404(通才组).对于贡吉分类系统,观察者间协议的平均kappa值为0.455,范围为0.480(专科组)至0.485(通才组).
结论:一般来说,3D-CT扫描提供了更丰富的经验,可以在大多数锁骨外侧骨折分类系统中获得更好的结果,突出数字化和专业化在诊断和治疗中的价值。使用贡吉分类系统在通才小组中展示了竞争性的观察员协议,这表明Gongji分类适用于在肩部领域经验不丰富的普通创伤外科医生。
OBJECTIVE: Distal clavicle fracture classification directly affects the treatment decisions. It is unclear whether the classification systems implemented differ depending on surgeons\' backgrounds. This study aimed to compare the interobserver agreement of four classification systems used for lateral clavicle fractures by shoulder specialists and general trauma surgeons.
METHODS: Radiographs of 20 lateral clavicle fractures representing a full spectrum of adult fracture patterns were analyzed by eight experienced shoulder specialists and eight general trauma surgeons from 10 different hospitals. All cases were graded according to the Orthopedic Trauma Association (OTA), Neer, Jäger/Breitner, and Gongji classification systems. To measure observer agreement, Fleiss\' kappa coefficient (κ) was applied and assessed.
RESULTS: When only X-ray films were presented, both groups achieved fair agreement. However, when the 3D-CT scan images were provided, improved interobserver agreement was found in the specialist group when the OTA, Jäger/Breitner, and Gongji classification systems were used. In the generalist groups, improved agreement was found when using the Gongji classification system. In terms of interobserver reliability, the OTA, Neer, and Jäger/Breitner classification systems showed better agreement among shoulder specialists, while a slightly lower level of agreement was found using the Gongji classification system. For the OTA classification system, interobserver agreement had a mean kappa value of 0.418, ranging from 0.446 (specialist group) to 0.402 (generalist group). For the Neer classification system, interobserver agreement had a mean kappa value of 0.368, ranging from 0.402 (specialist group) to 0.390 (generalist group). For the Jäger/Breitner classification system, the inter-observer agreement had a mean kappa value of 0.380, ranging from 0.413 (specialist group) to 0.404 (generalist group). For the Gongji classification system, interobserver agreement had a mean kappa value of 0.455, ranging from 0.480 (specialist group) to 0.485 (generalist group).
CONCLUSIONS: Generally speaking, 3D-CT scans provide a richer experience that can lead to better results in most classification systems of lateral clavicle fractures, highlighting the value of digitization and specialization in diagnosis and treatment. Competitive interobserver agreement was exhibited in the generalist group using the Gongji classification system, suggesting that the Gongji classification is suitable for general trauma surgeons who are not highly experienced in the shoulder field.