肱骨近端骨折 Neer 分型系统临床应用差异性探讨

摘要

目的分析Neer分型系统的临床应用差异性。方法收集我院2006年2月～2011年5月收治的86例肱骨近端骨折患者病例资料，将医师分为两组即专科组（曾行肩关节外科专科培训的创伤医师组）和普通组（未行培训的创伤医师组），分别对上述资料进行阅片分型测试，测试分2步共4次，第1步在普通X线片下进行，第2步阅片附加提供CT片，分别在2周后各重复1次；统计学分析运用Kappa检验分析组间可信度及组内可重复性，采用t检验比较专科培训组与普通组医师分型的差异性。结果4次阅片Neer分型组间取得较好的可信度及组内可重复性，专业组分型可靠性显著高于对照组，差异有统计学意义（P＜0．05）。结论规范的肩关节专业化培训及CT影像学辅助可提高Neer分型的准确性。%Objective To analyze the clinical application difference of Neer classification system in manag-ing proximal humeral fractures .Methods Data of 86 patients with proximal humeral fractures admitted into our hospital from Feb.2006 to May 2011 were collected and analyzed .The 86 patients were divided into specialist train-ing group(surgeons received shoulder joint specialized training )and control group (surgeons didn't receive any spe-cialized training).The two groups were tested in 2 steps,which were conducted through reading X ray film and CT slice.In addition,the test was repeated every 2 weeks.Statistical analysis was conducted using Kappa test for ana-lyzing reliability and repeatability;T test was conducted to compare the classification difference between the two groups.Results Four times X ray and CT film reading achieved good reliability and repeatability between the two groups;the reliability in the specialization training group was significantly higher than the control group ,indicating statistically significant difference (P<0.05).Conclusion Standard specialized training for shoulder joint treat-ment and auxiliary CT imaging can improve the accuracy of Neer classification .