骨质疏松性胸腰椎骨折评分及分型系统的可信度检验和临床应用效果评价  

Reliability testing and clinical effectiveness evaluation of the scoring and classification system for osteoporotic thoracolumbar fracture

作　　者：李庆达 张嘉男 贺宝荣[1] 冯世庆 高延征[3] 舒钧[4] 王浩[5] 蒋电明 丁文元[7] 贺园 杨俊松[1] 张正平[1] 尹新华[1] 郑博隆[1] 黄云飞 李大同 郭瑞 安浩 王晓晖 刘团江[1] 郝定均[1] Li Qingda;Zhang Jianan;He Baorong;Feng Shiqing;Gao Yanzheng;Shu Jun;Wang Hao;Jiang Dianming;Ding Wenyuan;He Yuan;Yang Junsong;Zhang Zhengping;Yin Xinhua;Zheng Bolong;Huang Yunfei;Li Datong;Guo Rui;An Hao;Wang Xiaohui;Liu Tuanjiang;Hao Dingjun(Department of Spine Surgery,Honghui Hospital Affiliated to Xi′an Jiaotong University,Xi′an 710054,China;Department of Spine Surgery,Second Hospital of Shandong University,Jinan 250033,China;Department of Spine Surgery,Henan Provincial People′s Hospital,Zhengzhou 450003,China;Department of Spine Surgery,Second Affiliated Hospital of Kunming Medical University,Kunming 650106,China;Department of Spine Surgery,People′s Hospital of Xinjiang Uygur Autonomous Region,Uygur 830001,China;Department of Spine Surgery,Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China;Department of Spine Surgery,Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Spine Surgery,Xi′an Fifth People′s Hospital,Xi′an 710082,China)

机构地区：[1]西安交通大学附属红会医院脊柱外科,西安710054 [2]山东大学第二医院脊柱外科,济南250033 [3]河南省人民医院脊柱外科,郑州450003 [4]昆明医科大学第二附属医院脊柱外科,昆明650106 [5]新疆维吾尔自治区人民医院脊柱外科,乌鲁木齐830001 [6]重庆医科大学附属第三医院脊柱外科,重庆401120 [7]河北医科大学第三医院脊柱外科,石家庄050051 [8]西安市第五人民医院脊柱外科,西安710082

出　　处：《中华创伤杂志》2023年第11期980-990,共11页Chinese Journal of Trauma

基　　金：国家自然科学基金(81830077);陕西省重点研发计划项目(2023‑ZDLSF‑03)。

摘　　要：目的检验和评价骨质疏松性胸腰椎骨折(OTLF)评分及分型系统的可信度及临床应用效果。方法采用多中心回顾性病例系列研究分析2021年1月至2022年6月西安交通大学附属红会医院等8家医院收治的530例OTLF患者的临床资料,其中男212例,女318例;年龄55~90岁[(72.6±10.8)岁]。美国脊髓损伤协会(ASIA)分级:C级4例,D级18例。根据骨质疏松性胸腰椎损伤分类及严重程度(OTLICS)评分,本组患者OTLICS评分均>4分,需行手术治疗。急性症状性OTLF(ASOTLF)分型410例,其中Ⅰ型24例,ⅡA型159例,ⅡB型47例,ⅡC型31例,ⅢA型136例,ⅢB型8例,Ⅳ型(无神经症状)2例,Ⅳ型(合并神经症状)3例。陈旧性症状性OTLF(CSOTLF)分型120例,其中Ⅰ型62例,Ⅱ型21例,Ⅲ型17例,Ⅳ型(全身麻醉下可复位)3例,Ⅳ型(全身麻醉下无法复位)9例,Ⅴ型(全身麻醉下可复位)1例,Ⅴ型(合并神经症状)5例,Ⅴ型(全身麻醉下无法复位)2例。患者分别采用经皮椎体成形术(PVP)、体位复位+PVP、经皮椎体后凸成形术(PKP)、后路切开复位植骨融合钉道强化内固定术、后路切开复位减压植骨融合钉道强化内固定术、后路切开复位截骨矫形植骨融合钉道强化内固定术。采用加权Kappa方法检验OTLICS评分、ASOTLF分型及CSOTLF分型的观察者间及观察者内可信度。比较术前、术后1个月及末次随访时视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、美国脊髓损伤协会(ASIA)分级。观察术后并发症发生情况。结果OTLICS评分观察者间平均评分一致性的百分比为93.4%,可信度Kappa值均值为0.86;观察者内平均评分一致性的百分比为93.0%,可信度Kappa值均值为0.86。ASOTLF分型观察者间平均分型一致性的百分比为94.2%,可信度Kappa值均值为0.84;观察者内平均分型一致性的百分比为92.5%,可信度Kappa值均值为0.83。CSOTLF分型观察者间平均评分一致性的百分比为91.9%,可信度Kappa值均值为0.80;观察者Objective To test and evaluate the reliability and clinical effectiveness of osteoporotic thoracolumbar fracture(OTLF)scoring and classification system.Methods A multicenter retrospective case series study was conducted to analyze the clinical data of 530 OTLF patients admitted to 8 hospitals including Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2021 to June 2022.There were 212 males and 318 females,aged 55-90 years[(72.6±10.8)years].There were 4 patients with grade C and 18 with grade D according to American Spinal Injury Association(ASIA)classification.According to the osteoporotic thoracolumbar injury classification and severity(OTLICS)score,all patients had an OTLICS score over 4 points and required surgical treatment.Among them,410 patients had acute symptomatic OTLF(ASOTLF),including 24 patients with type I,159 type IIA,47 type IIB,31 type IIC,136 type IIIA,8 type IIIB,2 type IV(absence of neurological symptoms)and 3 type IV(presence of neurological symptoms),and 120 patients had chronic symptomatic OTLF(CSOTLF),including 62 patients with type I,21 type II,17 type III,3 type IV(reducible under general anesthesia),9 type IV(not reducible under general anesthesia),1 type V(reducible under general anesthesia),5 type V(presence of neurological symptoms),and 2 type V(not reducible under general anesthesia).Surgical procedures included percutaneous vertebroplasty(PVP),positional repositioning plus PVP,percutaneous kyphoplasty(PKP),posterior open reduction combined with bone graft fusion and bone cement augmented screw internal fixation,posterior open reduction combined with decompression,bone graft fusion and bone cement augmented screw internal fixation,and posterior open reduction combined with osteotomy and orthopedics,bone graft fusion and bone cement augmented screw internal fixation.A weighted Kappa was used to test the interobserver and intraobserver reliability of the OTLICS score,the ASOTLF classification,and the CSOTLF classification.The visual analog scale(VAS),Oswestry disab

关 键 词：骨质疏松 脊柱骨折 老年人 损伤严重度评分 结果可重复性 

分 类 号：R580[医药卫生—内分泌] R683.2[医药卫生—内科学]