Bilgisayarlı Tomografi İntertrokanterik Kırık Tedavisinde X-ray’e göre avantaj sağlar mı?

Abstract

Amaç: İntertrokanterik kırıklarda başarılı bir tedavi uygun bir implanta bağlıdır ve buna kırık sınıflaması ve stabilitesine göre karar verilir. Çalışmamızda intertrokanterik kırıklarda x-ray ve/veya bilgisayarlı tomografi (BT)’nin kırık sınıflamasında ve tedavi için implant seçiminde gözlemciler arası ve gözlemci içi tutarlılığını araştırmayı amaçladık. Gereç ve Yöntemler: Travma tecrübesi beş yıl ve üzerinde olan iki ortopedist tarafından 80 intertrokanterik kırık tanısı almış aynı zamanda eşlik eden kırık şüphesine yönelik pelvis BT taraması yapılmış hastalar değerlendirmeye alındı. AO/OTA sınıflaması ve tedavi için implant seçimi x-ray ve/veya BT ye göre yapıldı. İki hafta sonra ikinci değerlendirler yapıldı. Birinci değerlendirme gözlemciler arası güvenilirlik, birinci ve ikinci değerlendirmelerde gözlemci içi güvenilirlik açısından Cohen's Kappa hesaplandı. Bulgular: Tüm değerlendirmelerde Gözlemci-1 için gözlemci içi ICC 0,861 ile 0,973 aralığında, Gözlemci-2 için 0,893 ile 0,993 aralığındaydı. Birinci değerlendirmeler dikkate alındığında gözlemciler arası ICC 0,865-0,961 aralığındaydı. Bu veriler her iki gözlemci için gözlemci içi ve gözlemciler arası mükemmel uyumu temsil ediyordu (P<0.001). Sonuç: Preoperatif BT taraması, özellikle x-ray’e göre stabil (AO/OTA-31A1) olarak değerlendirilen intertrokanterik kırıklarda tedavide implant tercihi için tanısal bir yarar sağlayabilir. Her ne kadar BT tarama analizi sonuçları mükemmel olsada, bu görüntüleme yöntemi cerrahi prosedürü planlamak ve optimize etmek için duruma göre kullanılmalıdır.

Keywords

• İntertrokanterik kırık
• İmplant tercihi
• gözlemciler-arası tutarlılık
• Optimize cerrahi prosedür

Does Computed Tomography Provide an Advantage over X-ray in the Treatment of Intertrochanteric Fractures?

Abstract

Objective: Successful treatment of intertrochanteric fractures depends on an appropriate implant and is decided according to fracture classification and stability. In the present study, the purpose was to investigate the interobserver and intraobserver consistency of x-ray and/or Computed Tomography (CT) in fracture classification and implant preference for treatment in intertrochanteric fractures. Materials and Methods: The patients who were diagnosed with 80 intertrochanteric fractures by two orthopedists with 5 or more years of trauma experience and who had pelvic CT scans for suspected accompanying fractures were evaluated in the study. AO/OTA classification and implant preference for treatment were based on x-ray and/or CT. Second evaluations were made two weeks later. Cohen’s Kappa was calculated for interobserver reliability in the first evaluation and intraobserver reliability in the first and second evaluations. Results: Intra-observer ICC ranged between 0.861 and 0.973 for Observer-1 and between 0.893 and 0.993 for Observer-2 in all evaluations. Inter-observer ICC was within the range of 0.865-0.961 based on primary evaluations. These data represented excellent intra- and inter-observer consistency for both observers (P<0.001). Conclusion: Preoperative CT scans may provide diagnostic benefits for implant preference, especially in intertrochanteric fractures evaluated as stable (AO/OTA-31A1) according to x-ray. Although CT scan analysis results are excellent, this imaging modality should be used on a case-by-case basis to plan and optimize surgical procedures.

Keywords

• Intertrochanteric fracture
• Implant preference
• Inter-observer consistency
• Optimize surgical procedures

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