医师训练水平对青少年特发性脊柱侧凸 PUMC 分型可信度的影响  

Level of Professional Training for Interobserver and Intraobserver Agreement of PUMC Classifications for Idiopathic Scoliosis

作　　者：王宇仁[1] 王晖[1] 蒋盛旦[1] 郑新峰[1] 盛伟斌[2] 陈晓东[1] 蒋雷生[1] 

机构地区：[1]上海交通大学医学院附属新华医院骨科 [2]新疆医科大学第一附属医院脊柱外科

出　　处：《解剖与临床》2013年第5期406-409,共4页Anatomy and Clinics

摘　　要：目的：评价不同训练水平的医师对特发性脊柱侧凸PUMC分型可信度的影响。方法：3名具有不同特发性脊柱侧凸诊治经验的医师对80例特发性脊柱侧凸患者的术前站立位全脊柱正、侧位和仰卧位Bending像进行两次测量并分型，两次间隔2周。计算平均百分比确定分型一致率，应用Kappa值判定可信度。结果：PUMC分型的3大型观察者自身前后一致性和观察者之间一致性极佳。 PUMC分型的13个亚型，3名观察者自身前后一致性和观察者之间一致性均为良好到极佳。观察者1自身前后分型一致性最差（Kappa值为0．738），观察者2其次（Kappa值为0．770），观察者3最好（Kappa值为0．903）。观察者之间一致性结果提示观察者2 vs 3一致性最好（Kappa值为0．770）；观察者1 vs 2和观察者1 vs 3分型一致性结果接近（Kappa值分别为0．739和0．737）。结论：PUMC三大型以及亚型的分型一致性均较好，医师训练水平在一定程度上影响PUMC分型的一致性。Objective：To determine whether the level of professional training would affect reliability of PUMC classification for adolescent idiopathic scoliosis .Methods：Examinations of preoperative radiographs （ standing full-length posteroanterior , lateral and two supine side -bending radiographs ） of 80 cases were per-formed by 3 orthopedic surgeons with a completely different degree of professional training according to PUMC ’ s criteria twice at the interval of two weeks .Kappa statistics were used to determine intraobserver and interob-server agreement .Results：The PUMC type demonstrated excellent intraobserver and interobserver reliability . While the subtype demonstrated good to excellent intraobserver and interobserver agreement .Among them, the intraobserver agreement for Observer 1 was the lowest with kappa coefficients of 0.738, while the intraobserver agreement for Observer 3 was the highest with kappa coefficients of 0.903.The intraobserver agreement was middle with kappa coefficients of 0.770.A maximum kappa coefficient of 0.770 for the pair of Observer 2 and Observer 3 was determined and 0.739 and 0.737 for the other two pairs of observers were shown .Conclusions：The results confirm that both PUMC type and subtype have a good reliability .The degree of professional training seems to influence the reliability of PUMC classification .

关 键 词：特发性 脊柱侧凸 脊柱后凸 PUMC分型 一致性 

分 类 号：R726.8[医药卫生—儿科]