新型胸腰椎骨折损伤AO分型系统的可信度和可重复性研究  

Intraobserver and interobserver reliability of the New AOSpine Thoracolumbar Spine Injury Classification System

作　　者：王丙超[1] 徐韬[1] 甫拉提·买买提[1] 曹锐[1] 邓强[1] 荀传辉[1] 王健[1] 盛伟斌[1] 

机构地区：[1]新疆医科大学第一附属医院脊桎外科,新疆乌鲁木齐市830054

出　　处：《中国脊柱脊髓杂志》2016年第7期602-608,共7页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:评价新型胸腰椎骨折损伤AO分型系统的可信度和可重复性,探讨影响分型一致性的主要原因。方法:选取5名医师,根据术前正侧位X线片、CT、MRI影像,用新型AO分型系统独立对收治的70例胸腰椎骨折损伤患者进行分型。对同一例患者,5名医师在一次分型中只要有1名医师分型不同即认定为不一致。6周后,打乱资料顺序再次分型。全部资料均不含与分型有关的任何标记,应用加权Cohen′s Kappa系数(unweighted Cohen Kappa coefficients)评价观察者间可信度和观察者内可重复性。结果:新型AO分型系统的可信度Kappa系数为0.602,可重复性平均Kappa系数为0.782。在3大骨折类型中,压缩型(A型)和分离移位型(C型)损伤的判定具有中、高度的可信度和极好的可重复性,可信度Kappa系数分别为0.604、0.662,可重复性平均Kappa系数分别为0.787、0.761;牵张型损伤(B型)判定的一致性相对较差,可信度Kappa系数为0.362,可重复性平均Kappa系数为0.657。损伤各亚型整体一致性,可信度Kappa系数为0.526,可重复性平均Kappa系数为0.701;其中B2型一致性最差,可信度Kappa系数为0.214,可重复性平均Kappa系数为0.633;其次为A4型,可信度Kappa系数为0.322,可重复性平均Kappa系数为0.685。结论:新型胸腰椎骨折损伤AO分型系统具有中、高度的一致性和极好的可重复性,但对A4和B2型骨折判定的可信度较差。Objectives： To evaluate the intraobserver and interobserver reliability and main influencing factors of the New AOSpine Thoracolumbar Spine Injury Classification System. Methods： Seventy thoracolumbar frac- ture patients with complete clinical data and radiologic data （including X-ray films, CT and MRI） were en- rolled. Five observers were assigned to independently determine the classifications according to the New AOSpine Thoracolumbar Spine Injury Classification System. If there was a observer in a different type, it was identified as inconsistent. After a 6-week interval, the 70 eases were presented in a random sequence to the same evaluators for repeated evaluation. The Cohen Kappa coefficient（K） was used to determine the interob- server and intraobserver reliability. Results： The New AOSpine Thoracolumbar Spine Injury Classification Sys- tem was found to have fair interobserver reliability and excellent intraobserver reliability. The interobsever and intraobsever reliability was Kappa=0.602 and Kappa=0.782, respeclively. The compression fracture（A type） and translation injury（C type） demonstrated fair interobserver reliability and excellent intraobserver reliability. The interobserver reliability was Kappa=0.604 and Kappa=0.662 respectively, while the intraobserver reliability was Kappa=0.787 and Kappa=0.761 respectively. The AO System had poor reliability in evaluation of the tension band injuries（B type）. The interobserver reliability was Kappa=0.362 and the intraobserver reliability was Kap- pa=0.657. The interobserver reliability of the overall subtypes was Kappa=0.526 and the intraobserver reliabil- ity was Kappa=0.701, in which the poorest reliability in evaluation was the subtype of B2. The interobserverreliability was Kappa=0.214 and the intraobserver reliability was Kappa=0.633. Followed was the subtype of A4. The interobserver reliability was Kappa=0.322 and the intraobserver reliability was Kappa=0.685. Conclusions： The new AOSpine Thoracolumbar Spine Injury Classificat

关 键 词：脊柱骨折 分型 胸腰椎 一致性 

分 类 号：R683.2[医药卫生—骨科学]