下颈椎损伤分型评分系统的可信度及可重复性研究  

Intraobserver and interobserver reliability of the Sub.axial injury classification evaluation system for sub-axial cervical spine injury

作　　者：于圣会[1] 池雷霆[2] 任永安[2] 顾祖超[2] 盛伟斌[1] 郭海龙[1] 甫拉提[1] 荀传辉[1] 徐韬[1] 

机构地区：[1]新疆医科大学第一附属医院脊柱外科,乌鲁木齐830054 [2]成都市第一人民医院骨科

出　　处：《中华创伤骨科杂志》2012年第3期193-197,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的评价下颈椎损伤分型（SLIC）评分系统的可信度及可重复性。方法应用SLIC评分系统对2008年5月至2010年4月收治的54例下颈椎损伤患者的术前正侧位X线片、CT、MRI和体格检查等无标记的影像及病历资料进行分型并评判。4周后，打乱资料顺序再次分型并评判。全部资料均不带与分型和（或）评分有关的任何标记。通过计算平均百分比确定分型一致率，应用Kappa值、组内相关系数（ICC）判定可信度和可重复性。结果SLIC评分系统中损伤形态和神经功能状况评判有中、高度一致性，可信度平均分别为62．7％（Kappa=0．502，ICC=0．581）、69．7％（Kappa=0．616，ICC=0．867），可重复性平均分别为71．8％（Kappa=0．631，ICC=0．746）、79．6％（Kappa=0．735，ICC=0．871）。椎间盘韧带复合体（DLC）损伤判定的一致性相对较差，可信度平均为55．8％（Kappa=0．317，ICC=0．483），可重复性平均为68．9％（Kappa=0．517，ICC：0．643）。总分一致性的可信度平均为30．7％（Kappa=0．218，ICC=0．725），可重复性平均为44．5％（Kappa=0．394，1CC=0．812）。治疗选择的可信度平均为72．4％（Kappa=0．431，ICC=0．578），可重复性平均为78．8％（Kappa：0．581，ICC=0．759）。结论SLIC评分系统中损伤形态、神经功能状况及治疗选择的评判有较好的一致性。MRI对判定韧带损伤的不确定性是影响DLC损伤一致性评判的重要因素。Objective To evaluate the intraobserver and intreobserver reliability of the Sub-axial Injury Classification （SLIC） evaluation system for sub-axial cervical spine injury. Methods The preoperative imaging data （posteroanterior and lateral radiographs, CT, MRI） and clinical data which had not been premeasured were evaluated and classified using SLIC system in the 54 patients with sub-axial cervical spine injury who had been treated in our department between May 2008 and April 2010. The same data which had been presented in a different order were evaluated and classified again 4 weeks later in a same manner. The average percentages of intraobserver and interobserver agreements were calculated. The reliability and reproducibility were quantified using kappa statistics and intraclass correlation coefficients （ICC）. Results The SLIC system was found to have intermediate and high interobserver and intraobserver agreements respectively in evaluation of the morphology and neurological function of the injury. The interobserver reliabilities were 62. 7% （ Kappa = 0. 502, ICC = 0. 581） and 69.7% （ Kappa = 0. 616, ICC = 0. 867） respectively while the intraobserver reliabil- ities were 71.8% （ Kappa = 0. 631, ICC = 0. 746） and 79. 6% （ Kappa = 0. 735, ICC = 0.871） respectively. The SLIC system had poor interobserver and intraobserver agreement in evaluation of disco-ligamentous complex （DLC） injury. The interobserver reliability was 55.8% （ Kappa = 0. 317, ICC = 0. 483） and the intraobserver reliability was 68.9% （Kappa =0. 517, ICC=0. 643） . The global SLIC evaluation obtained an interobserver reliability of 30. 7% （Kappa = 0. 218, ICC = 0. 725） and an intraobserver reliability of 44. 5% （Kappa = 0. 394, ICC = 0. 812）. For therapy selection, the interobserver reliability was 72.4% （ Kappa =0.431, ICC =0. 578） and the intraobserver reliability was 78.8% （ Kappa = 0. 581, ICC = 0. 759） . Conclusions The SLIC system has excellent interobserver and intraobserver agreements i

关 键 词：颈椎 创伤和损伤 可靠性和有效性 

分 类 号：R687.3[医药卫生—骨科学]