脊柱侧凸胸椎椎弓根形态学分型系统的可信度与可重复性研究  

Reliability and reproducibility of morphologic classification for thoracic pedicles in scoliosis

作　　者：姜亦坤[1] 刘一[1] 付长峰[1] 

机构地区：[1]吉林大学第二医院脊柱外科,吉林省长春市130041

出　　处：《中国脊柱脊髓杂志》2013年第2期109-112,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：目的：探讨脊柱侧凸胸椎椎弓根形态学分型系统在临床应用中的可信度与可重复性。方法：1998年1月～2009年1月手术治疗脊柱侧凸患者60例，术前均行胸椎CT扫描、椎弓根轴位薄层重建。根据椎弓根松质骨管腔的形态特征将脊柱侧凸胸椎椎弓根分为正常型、狭窄型、峡部硬化型、完全硬化型（包括凹陷硬化和平直硬化两个亚型）和缺如型。应用64排CT多层重建技术，测量、分析60例常见类型脊柱侧凸患者1440个胸椎椎弓根CT轴位扫描结果．由3位不了解本研究目的的脊柱外科高年资住院医师．在同一时间分别对1440个胸椎椎弓根CT轴位扫描结果进行分型。间隔1个月后，再次由这3位住院医师对这1440个椎弓根进行分型。应用Stata10．0软件，运用多类别多评估者的Kappa分析方法进行统计学分析，评价观察者间的可信度及观察者内的可重复性。结果：3位医师之间首次分型结果相同的百分比分别为88％、84％、92％，可信度的Kappa系数分别为0．7647、0．6590、0．8292；同一医师前后两次分型结果相同的百分比分别为95％、97％、96％，可重复性的Kappa系数分别为0．9227、0．9513、0．9117。结论：脊柱侧凸胸椎椎弓根形态学分型系统具有中、高度的可信度和极好的町重复性。Objectives： To investigate the reliability and inter-observer reproducibility of scoliosis thoracic pedicle classification system and its clinical applications. Methods： From January 1998 to January 2009, 60 patients with scoliosis underwent surgical treatment, preoperative CT scan was performed in all patients, and the pedicle of vertebral arch axis thin layer reconstruction was performed. According to the morphological characteristics of cancellous bone, the thoracic pedicles were divided into normal type, narrow type, isthmic sclerosis, complete sclerosis（including two subtypes of concave sclerosis and straight sclerosis） and the pedicle absence. Bsaed on the 64-slice CT technology, multi-layer reconstruction, the 1440 thoracic pedicle axial CT scan results from the 60 cases were classified by three senior spine surgeons who knew nothing about the re- search at the same time. A month later, the procedure repeated. Statistical analysis on multiple categories and multiple observers was performed by Stata 10.0 software and the Kappa statistics to evaluate the credibility of inter-observer and the repeatability of intra-observer. Results： For the first results of classification among the three senior spine surgeons： the percentage of result for three spine surgeons was 88%, 84% and 92% re- spectively, and the Kappa coefficients was 0.7647, 0.6590 and 0.8292 respectively; while for the second re- sults from the same spine surgeon： the percentage of result was 95%, 97% and 96% respectively, and the Kappa coefficient was 0.9227, 0.9513 and 0.9117 respectively. Conclusions： The morphologic classification of thoracic pedicles in scoliosis has moderate reliability and excellent reproducibility.

关 键 词：脊柱侧凸 椎弓根 形态学分型 可信度 可重复性 

分 类 号：R682.3[医药卫生—骨科学]