脊柱侧凸Lenke分型和PUMC分型系统一致性差异对手术融合范围影响的比较研究

Comparative study of effect of reliability between Lenke and PUMC classification systems for adolescent idiopathic scoliosis upon surgical fusion range

目的比较脊柱侧凸Lenke分型和协和（PUMC）SY型系统一致性差异对手术融合范围的影响。方法随机选取青少年特发性脊柱侧凸62例，5名脊柱外科医生根据术前站立正侧位、仰卧位左右弯曲X线片进行分型。3周后，将病例顺序打乱，重复相同程序分型，每个病例共计10人次分型。根据5名医生的分型结果，分别探讨两种分型产生的一致性差异对手术融合范围选择的影响。结果Lenke分型系统弯曲类型参数及PUMC分型的一致性均很好。Lenke分型弯曲类型参数10人次分型结果24例有分歧，PUMC分型10人次分型结果17例有分歧，差异无统计学意义。Lenke弯曲类型分歧病例中仅2例不影响融合范围，PUMC分歧病例中有7例不影响融合范围，差异有统计学意义。24例Lenke弯曲类型分歧病例用PUMC分型，有14例一致；17例PUMC分歧病例用Lenke弯曲类型分型，7例一致，但做一致性检验表明两种分型一致性好。24例Lenke弯曲类型分歧病例用PuMC分型后有19例不影响融合范围，17例PUMC分歧病例用Lenke弯曲类型分型后只有9例不影响融合范围，差异无统计学意义。结论Lenke分型中决定手术融合范围的是弯曲类型参数，其与PUMC分型的可信度和可重复性均很好。但PUMC分型较简单实用，较少引起分歧，即使引起分歧，也有近半数的病例并不影响手术融合范围的选择。

Objective To compare the effect of reliability between Lenke and Peking Union Medical College （PUMC） classification systems for Adolescent Idiopathic Scoliosis （AIS） upon surgical fusion range. Methods 62 scoliosis cases were classificated according to Lenke classification system and PUMC classification system by 5 spine surgeons, and each case was done twice. The reliability and consistency between the two classification systems were investigated and evaluated. Results The reliability and consistency were good-to-excellent in the curve type parameter of Lenke classification system and PUMC classification system. According to Lenke curve type classification, there were 24 cases of disagreements, 2 cases of them without effection to bone fusion. According PUMC classification, there were 17 cases of disagreements, 7 of them without effection to fusio. In the 24 Lenke disagreemrnt cases, 14 cases had the consistency result according to PUMC classification; while in 17 PUMC disagreement cases, 7 cases had the consistency result according to Lenke curve type classification. There were good coherence between the two classification systems. 24 Lenke disagreement cases categorized according to PUMC classification, 19 cases did not affect fusion range; while 17 PUMC disagreements cases placed under Lenke curve type classification only 9 cases did not affect fusion level. There were no significant difference. Conclusion In Lenke classification system curve type parameter determines fusion levels, sharing good-to-excellent reliability to the PUMC classification. However the PUMC classification is simpler in use, with fewer disagreements, as well as nearly half of disagreement cases not affecting fusion levels selection.