3种不同影像学分类系统对尺骨远端骨折的诊断价值

目的  比较3种不同影像学分类系统对尺骨远端骨折临床指导的可靠性和可重复性。方法  连续纳入2015~2020年因尺骨远端骨折就诊于我院的患者共61例，年龄63.3±17.1岁。由3位医师对每位患者的X线采用Biyani分类、国际内固定研究学会/骨科创伤协会（AO/OTA）2007和AO/OTA 2018分类系统独立分类。2周后重复评估。使用一致性评价（Kappa值）分析评估医师的观察者间和观察者内一致性。结果  Biyani分类的观察者间一致性为0.44，观察者内一致性为0.58；AO/OTA 2007分类的观察者间一致性为0.40，观察者内一致性为0.52；AO/OTA 2018分类的观察者间一致性为0.43，观察者内一致性为0.53（P < 0.05）。除AO/OTA 2007分类的观察者间一致性等级为一般外，其他观察者内和观察者间一致性等级均为中等。结论  3种分类之间的一致性差异较小，但临床指导价值较差。在Biyani分类上发展未来专用于尺骨远端骨折的专业分类方法，提高分类的准确性、可靠性和可重复性，有助于更好地指导临床治疗。

Diagnostic value of distal ulna fractures by 3 different imaging classification systems

  Objective  To compare the reliability and reproducibility of three different imaging classification systems for clinical guidance of distal ulnar fractures.  Methods  Sixty-one patients who visited our hospital for distal ulnar fractures from 2015 to 2020 were included with the age of 63.3 ± 17.1 years old. X-ray images of each patient were independently classified by 3 physicians using the Biyani, International Society for the Study of Internal Fixation/Orthopaedic Trauma Association (AO/OTA) 2007 and AO/OTA 2018 classification systems, and repeated assessment after 2 weeks. Interand intra observer agreement was assessed using consistency evaluation (Kappa value) analysis.  Results  Inter-observer agreement was 0.44 and intra-observer agreement was 0.58 for the Biyani classification. Inter-observer agreement was 0.40 and intra-observer agreement was 0.52 for the AO/OTA 2007 classification. Inter-observer agreement was 0.43 and intra-observer agreement was 0.53 for the AO/OTA 2018 classification and 0.53 for intra-observer agreement (P < 0.05). The intra- and inter-observer agreement grades were moderate, except for the inter-observer agreement grade of the AO/OTA 2007 classification, which was fair. Except for inter-observer agreement rating with an average using the AO/OTA 2007 classification, the intra-and inter-observer agreement ratings were moderate.  Conclusion  The consistency difference between the 3 classifications is not significant, but the clinical guidance value is poor. The development of specialized classification method dedicate to distal ulnar fractures based on Biyani classification will improve the accuracy, reliability and reproducibility of the classification and help to better guide clinical treatment.