髋臼后方包容角法和Keith法评价髋臼后壁骨折稳定性的对比研究
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摘要
目的探讨髋臼后方包容角法评价髋臼后壁骨折髋臼后方稳定性的临床价值。方法选取30例单侧髋臼后壁骨折患者,在CT上分别采用髋臼后方包容角法和Keith法评估髋臼后方的稳定性,并对判定结果进行对比。结果髋臼后方的完全包容角、稳定包容角和不稳定包容角的平均值分别为92.38°±10.53°、73.86°±9.36°、51.90°±6.43°,2名测量人员自身和两者之间的组内相关系数(ICC)均>0.95,说明此方法的可信度高且可重复性好。Keith法和髋臼后方包容角法对髋臼后方稳定性的判定结果具有高度一致性,Kappa值为0.824。以髋臼后方稳定性试验为参照,髋臼后方包容角法判定髋臼后方稳定性的特异性、敏感性和准确率均高于Keith法,但差异无统计学意义(χ2=0.834、0.764、0.904,P>0.05)。结论髋臼后方包容角法与传统的Keith法在髋臼后壁骨折稳定性的判定结果基本一致,但该法不需参照对侧,操作简单,实用性强,尤其适用于对侧髋臼合并骨折或有先天性畸形的患者。
Objective To explore the clinical value of the acetabular posterior arc angle method in evaluating the stability of posterior wall fracture of the acetabulum. Methods 30 patients with unilateral posterior wall fracture of acetabulum were recorded. Acetabular posterior arc angle method and Keith method were used to evaluate the stability of posterior wall fracture of acetabulum on the CT,and the results were compared. Results The average fully arc angle,stable arc angle and unstable arc angle respectively were 92. 38° ± 10. 53°,73. 86° ± 9. 36°,51. 90° ± 6. 43°,the intraclass correlation coefficient( ICC) of the two surveyors were greater than 0. 95,which showed that this method had highly reliability and good repeatability. The determination results of the acetabular posterior arc angle method and Keith method in evaluating the stability of posterior wall fracture of acetabulum were highly consistent,Kappa value was 0. 824. Using acetabulum posterior stability test for reference,the specificity,sensitivity and accuracy of the acetabular posterior arc angle method were higher than Keith method,but there was no statistically significant difference( χ2= 0. 834,0. 764,0. 904,P > 0. 05). Conclusions The determination results of the acetabular posterior arc angle method and Keith method in evaluating the stability of posterior wall fracture of acetabulum are highly consistent,it does not need to consult the contralateral side,easy to operate,has strong practicability,especially applicable to the patients who combine the contralateral acetabulum fracture or with congenital malformation.
Objective To explore the clinical value of the acetabular posterior arc angle method in evaluating the stability of posterior wall fracture of the acetabulum. Methods 30 patients with unilateral posterior wall fracture of acetabulum were recorded. Acetabular posterior arc angle method and Keith method were used to evaluate the stability of posterior wall fracture of acetabulum on the CT,and the results were compared. Results The average fully arc angle,stable arc angle and unstable arc angle respectively were 92. 38° ± 10. 53°,73. 86° ± 9. 36°,51. 90° ± 6. 43°,the intraclass correlation coefficient( ICC) of the two surveyors were greater than 0. 95,which showed that this method had highly reliability and good repeatability. The determination results of the acetabular posterior arc angle method and Keith method in evaluating the stability of posterior wall fracture of acetabulum were highly consistent,Kappa value was 0. 824. Using acetabulum posterior stability test for reference,the specificity,sensitivity and accuracy of the acetabular posterior arc angle method were higher than Keith method,but there was no statistically significant difference( χ2= 0. 834,0. 764,0. 904,P > 0. 05). Conclusions The determination results of the acetabular posterior arc angle method and Keith method in evaluating the stability of posterior wall fracture of acetabulum are highly consistent,it does not need to consult the contralateral side,easy to operate,has strong practicability,especially applicable to the patients who combine the contralateral acetabulum fracture or with congenital malformation.
引文
[1]Harnroongroj T,Riansuwan K,Sudjai N,et al.Posterior acetabular arc angle of unstable posterior hip fracture-dislocation[J].Int Orthop,2013,37(12):2443-2449.
[2]Harnroongroj T,Suangyanon P,Tharmviboonsri T,et al.Posterior acetabular arc angle of the femoral head assesses instability of posterior fracture-dislocation of the hip[J].Int Orthop,2013,37(6):1141-1145.
[3]Senohradski K,Karovic B,Miric D.Computer tomography in the diagnosis and therapy of acetabular fractures[J].Srp Arh Celok Lek,2001,129(8):194-198.
[4]刘勃,张英泽.髋臼后壁骨折的手术策略[J].中华创伤杂志,2013,29(1):85-88.
[5]刘百伟,李云峰,王晖,等.手术内固定治疗髋臼后壁粉碎骨折[J].临床骨科杂志,2013,16(4):459-459.
[6]杜浩,郭锐,吴涛,等.两种评分系统对髋臼后壁骨折的预后评价[J].中国矫形外科杂志,2008,16(20):1538-1540.
[7]Grimshaw C S,Moed B R.Outcomes of posterior wall fractures of the acetabulum treated nonoperatively after diagnostic screening with dynamic stress examination under anesthesia[J].J Bone Joint Surg Am,2010,92(17):2792-2800.
[8]Moed B R,Ajibade D A,Israel H.Computed tomography as a predictor of hip stability status in posterior wall fractures of the acetabulum[J].J Orthop Trauma,2009,23(1):7-15.
[9]刘欣伟,魏显招,王志伟,等.髋臼骨折ABC分类系统的可信度评价[J].第二军医大学学报,2012,33(5):510-513.
[10]王满宜.骨盆与髋臼骨折值得注意的问题[J].中华骨科杂志,2011,31(11):1181-1182.
[11]许猛,张立海,张里程,等.复杂髋臼骨折术中应用CT扫描的意义[J].中华骨科杂志,2011,31(11):1261-1265.
[12]Reagan J M,Moed B R.Can computed tomography predict hip stability in posterior wall acetabular fractures?[J].Clin Orthop Relat Res,2011,469(7):2035-2041.
[13]姚运峰,张积森,吕浩,等.重建钢板内固定治疗髋关节后脱位伴髋臼后壁骨折[J].临床骨科杂志,2013,16(4):395-397.
[2]Harnroongroj T,Suangyanon P,Tharmviboonsri T,et al.Posterior acetabular arc angle of the femoral head assesses instability of posterior fracture-dislocation of the hip[J].Int Orthop,2013,37(6):1141-1145.
[3]Senohradski K,Karovic B,Miric D.Computer tomography in the diagnosis and therapy of acetabular fractures[J].Srp Arh Celok Lek,2001,129(8):194-198.
[4]刘勃,张英泽.髋臼后壁骨折的手术策略[J].中华创伤杂志,2013,29(1):85-88.
[5]刘百伟,李云峰,王晖,等.手术内固定治疗髋臼后壁粉碎骨折[J].临床骨科杂志,2013,16(4):459-459.
[6]杜浩,郭锐,吴涛,等.两种评分系统对髋臼后壁骨折的预后评价[J].中国矫形外科杂志,2008,16(20):1538-1540.
[7]Grimshaw C S,Moed B R.Outcomes of posterior wall fractures of the acetabulum treated nonoperatively after diagnostic screening with dynamic stress examination under anesthesia[J].J Bone Joint Surg Am,2010,92(17):2792-2800.
[8]Moed B R,Ajibade D A,Israel H.Computed tomography as a predictor of hip stability status in posterior wall fractures of the acetabulum[J].J Orthop Trauma,2009,23(1):7-15.
[9]刘欣伟,魏显招,王志伟,等.髋臼骨折ABC分类系统的可信度评价[J].第二军医大学学报,2012,33(5):510-513.
[10]王满宜.骨盆与髋臼骨折值得注意的问题[J].中华骨科杂志,2011,31(11):1181-1182.
[11]许猛,张立海,张里程,等.复杂髋臼骨折术中应用CT扫描的意义[J].中华骨科杂志,2011,31(11):1261-1265.
[12]Reagan J M,Moed B R.Can computed tomography predict hip stability in posterior wall acetabular fractures?[J].Clin Orthop Relat Res,2011,469(7):2035-2041.
[13]姚运峰,张积森,吕浩,等.重建钢板内固定治疗髋关节后脱位伴髋臼后壁骨折[J].临床骨科杂志,2013,16(4):395-397.
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