脊柱侧凸Lenke分型和PUMC分型系统可信度和可重复性的对比分析研究  

Comparative analysis of the inter-observer reliability and intra-observer reproducibility between Lenke and PUMC classification systems for adolescent idiopathic scoliosis

作　　者：邱贵兴[1] 李其一[1] 王以朋[1] 仉建国[1] 于斌[1] 王亭[2] 余可谊[1] 钱军[1] 赵宇[1] 李佳忆[1] 沈健雄[1] 翁习生[1] 杨新宇[1] 

机构地区：[1]中国医学科学院 中国协和医科大学 北京协和医院骨科,100730 [2]青岛大学医学院附属医院骨科

出　　处：《中华医学杂志》2007年第33期2332-2335,共4页National Medical Journal of China

摘　　要：目的对特发性脊柱侧凸的 Lenke 分型系统和中国协和医科大学北京协和医院(PUMC)分型系统进行对比研究,比较其不同观察者间的可信度和同一观察者内的可重复性。方法5名脊柱外科医师对62例手术治疗的青少年特发性脊柱侧凸的术前 X 线片独自进行测量,使用Lenke 分型和 PUMC 分型系统分别进行评估和分型。3周后,再由这位医师重复同样的程序分型。每位医师测量过的 X 线片均不能遗留任何标记。收集结果,分别作不同观察者间可信度和同一观察者内可重复性的分析,计算κ值,检验一致性,将两种分型系统进行对比研究。结果 Lenke 分型系统的总体可信度和可重复性分别平均为69.8%(κ=0.675)和74.2%(κ=0.690)。其中弯曲类型的可信度和可重复性分别平均为86.5%(κ=0.808)和87.4%(κ=0.826);腰椎修正的可信度和可重复性分别平均为95.2%(κ=0.919)和94.5%(κ=0.908);胸椎矢状面修正的可信度和可重复性分别平均为85.2%(κ=0.734)和89.0%(κ=0.805)。PUMC 分型系统的可信度和可重复性分别平均为91.0%(κ=0.896)和90.2%(κ=0.892)。结论 Lenke 分型系统的可信度和可重复性好。PUMC 分型系统的可信度和可重复性更好。Lenke 和 PUMC 分型系统均比较全面,但 PUMC 分型系统相对简单,包含的类型较少,临床医师进行分型时所产生的分歧少,对手术有指导意义。Objective To compare the intra-observer reproducibility and inter-observer reliability regarding the results of Lenke＇s and Peking Union Medical College （PUMC） classification systems for adolescent idiopathic scoliosis （AIS）. Methods Five spine surgeons independently measured the X ray films of 62 AIS patients using both Lenke and PUMC classification systems. Three weeks later, the spine surgeons repeated the same classification process. No measurement trace was allowed to be left on the X ray films. SAS software was used to calculate the Kappa values and analyze the intra-observer reproducibility and inter-observer reliability Results The overall reliability and reproducibility rates of the Lenke classification system were 69.8% （ Kappa value = 0. 675 ） and 74.2% （ Kappa value = 0. 690） respectively, in which the curve characteristic parameter reliability and reproducibility rates were 86.5% （ Kappa value = 0. 808 ） and 87.4% （ Kappa value 0. 826 ） respectively, the lumbar correction reliability and reproducibility rates were 95.2% （ Kappa value = 0.919 ） and 94.5% （ Kappa value = 0. 908 ） respectively, and the sagittal thoracic correction reliability and reproducibility rates were 85.2% （ Kappa value = 0. 734 ） and 89.0% （ Kappa value = 0. 805 respectively ）. The reliability and reproducibility rates of the PUMC classification system were 91.0% （ Kappa value = 0. 896 ） and 90. 2% （ Kappa value = 0. 892 ） respectively. Conclusion The reliability and reproducibility rates of the Lenke classification system were better than the previously reported results. However, the PUMC classification system expresses better reliability and reproducibility. The PUMC classification system is relatively easier with fewer curve types, hence leading to less divergence among the clinicians. Comparing to the classifications used in the past, both classification systems have the advantages of correctly categorizing AIS according to its individual traits, as well as accurately examini

关 键 词：脊柱侧凸 对比研究 分型 

分 类 号：R682[医药卫生—骨科学]