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首页> 外文期刊>Journal of Hand Surgery. American Volume >Radiographic diagnosis of scapholunate dissociation among intra-articular fractures of the distal radius: Interobserver reliability
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Radiographic diagnosis of scapholunate dissociation among intra-articular fractures of the distal radius: Interobserver reliability

机译：radius骨远端关节内骨折中肩cap骨分离的影像学诊断：观察者间的可靠性

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摘要

Purpose: To evaluate the reliability and accuracy of diagnosis of scapholunate dissociation (SLD) among AO type C (compression articular) fractures of the distal radius. Methods: A total of 217 surgeons evaluated 21 sets of radiographs with type C fractures of the distal radius for which the status of the scapholunate interosseous ligament was established by preoperative 3-compartment computed tomographic arthrography with direct operative visualization of diagnosed SLD (reference standard). Observers were asked whether SLD was present, and if yes, whether they would recommend operative treatment. Diagnostic performance characteristics were calculated with respect to the reference standard. We assessed interobserver reliability using the Fleiss generalized kappa. Results: The interobserver agreement for radiographic diagnosis of SLD was moderate (κ = 0.44). Correct diagnosis for a given set of radiographs ranged from 8% to 98% (average, 79%) of observers. Diagnostic performance characteristics were: 69% sensitivity, 84% specificity, 84% accuracy, 68% positive predictive value, and 84% negative predictive value. Based on a prevalence of 5%, Bayes adjusted positive and negative predictive values were 18% and 98%, respectively. Raters recommended operative treatment in 74% to 100% of patients diagnosed with SLD. Conclusions: Radiographs are moderately reliable and are better at ruling out than ruling in SLD associated with type C fracture of the distal radius. Type of study/level of evidence: Diagnostic III.
机译：目的：评估among骨远端AO C型（压迫关节）骨折中肩cap骨脱离的诊断的可靠性和准确性。方法：共有217名外科医生对21例远端radius骨C型骨折的X线照片进行了评估，并通过术前3室计算机断层扫描和直接手术可视化诊断SLD来确定肩cap骨骨间韧带的状态（参考标准） 。询问观察者是否存在SLD，如果存在，则建议手术治疗。根据参考标准计算诊断性能特征。我们使用Fleiss广义kappa评估了观察者之间的可靠性。结果：对于SLD的放射学诊断，观察者之间的一致性中等（κ= 0.44）。对于给定的X射线照片，正确的诊断范围为观察者的8％至98％（平均79％）。诊断性能特征为：69％敏感性，84％特异性，84％准确性，68％阳性预测值和84％阴性预测值。根据5％的患病率，贝叶斯调整后的阳性和阴性预测值分别为18％和98％。评分者建议对诊断为SLD的患者进行74％至100％的手术治疗。结论：X线片的可靠性中等，与SLD伴有C骨远端C型骨折相关的裁决相比，裁决更胜一筹。研究类型/证据水平：诊断III。

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