小柯机器人

德国汉诺威医学院Sam Razaeian团队比较了人和猕猴在肱骨近端骨折治疗中的非一致性。2020年12月14日，该研究发表在《英国医学杂志》上。

为了比较地中海猕猴与一组外科医生，在选择治疗方案和预测肱骨近端骨折预后方面的可信度，研究组设计了一项非对照、双盲、比较的行为分析研究，招募了10位来自德国和美国的骨科创伤外科领域专家，尤其擅长上肢外科手术，以及5只半自由放养的地中海猕猴。主要结局是衡量评分者之间协议的可靠性。

与专家相比，地中海猕猴在选择治疗方法（非手术或手术）方面的评分可靠性似乎较低，但对于最常受肱骨近端骨折影响的老年猕猴组，它们在选择治疗方法和手术方式方面的表现与专家组相似。

猕猴和专家对预测结果的共识都很差。所有专家几乎总是错误地预测结果，并倾向于低估它。在90位专家的预测中，只有4位（4.4％）是正确的，而在45只猕猴的预测中，有13只（28.9％）是正确的。

结果表明，人们对于肱骨近端骨折的治疗和预期结果缺乏共识，甚至在人类以外的物种亦是如此。尽管地中海猕猴倾向于更准确地预测临床结局，但它们协助外科医生做出一致决定的可靠性受到限制。未来需要进行高质量的研究，以指导外科医生对这种常见损伤的最佳治疗方法做出决策。

附：英文原文

Title: Nonsensus in the treatment of proximal humerus fractures: uncontrolled, blinded, comparative behavioural analysis between Homo chirurgicus accidentus and Macaca sylvanus

Author: Sam Razaeian, Birgitt Wiese, Dafang Zhang, Afif Harb, Christian Krettek, Nael Hawi

Issue&Volume: 2020/12/14

Abstract:

Objective To investigate the inter-rater reliability of Barbary macaques compared with an expert group of surgeons for the choice of treatment and predicted outcome of proximal humerus fractures.

Design Uncontrolled, blinded, comparative behavioural analysis.

Setting Germany and United States.

Participants 10 blinded experts in the field of orthopaedic trauma surgery (Homo chirurgicus accidentus), with special focus on upper extremity surgery from Germany and the US, and five Barbary macaques (Macaca sylvanus) from a semi-free range enclosure.

Main outcome measures The reliability of agreement between raters assessed with Fleiss’ .

Results Barbary macaques seem to have inferior inter-rater reliability in comparison with experts for choice of treatment (non-surgical v surgical), but for the geriatric age group most frequently affected by proximal humeral fractures, they performed similarly to the experts in their choices of treatment and choice of surgical procedure. Agreement about predicted outcome was poor among the macaques and slight among the experts. All experts almost always predicted the outcome incorrectly and tended to underestimate it. While only 4 (4.4%) of 90 experts’ predictions were correct, 13 (28.9%) of 45 macaques’ predictions were correct.

Conclusions Consensus on treatment and expected outcomes of proximal humeral fractures is lacking even beyond the human species. Although Barbary macaques tend to predict the clinical outcome more accurately, their reliability to assist surgeons in making a consistent decision is limited. Future high quality research is needed to guide surgeons’ decision making on the optimal treatment of this common injury.

DOI: 10.1136/bmj.m4429

Source: https://www.bmj.com/content/371/bmj.m4429

BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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