三种胸腰段骨折分类法的可信度和可重复性研究

Study of reliability and reproducibility of AO,Denis and TLICS classification systems for thoracolumbar fracture

目的:探讨并比较AO分型、Denis分类、TLICS评分分类系统在胸腰段骨折诊断中的可信度和可重复性。方法:选择临床及影像学资料(X线片、CT、MRI)完整的31例胸腰段骨折患者,将该31例患者的资料提供给6名骨科医生,分别采用AO分型、Denis分类、TLICS评分分类三种方法进行脊柱骨折分类。3个月后进行重复分类。采用加权Cohen′s Kappa系数评价观察者间可信度和观察者内可重复性。结果:AO分型、Denis分类、TLICS评分分类的观察者间平均Kappa系数分别为0.517、0.639、0.713;三种分类方法的观察者内平均Kappa系数分别为0.766、0.832、0.804。结论:三种胸腰段骨折分类方法比较,TLICS评分分类方法的可信度和可重复性较高,Denis分类方法次之,AO分型方法较差,前者更具临床实用价值。

Objective：To investigate and compare the reliability and reproducibility of AO,Denis and TLICS classification systems in the diagnosis of thoracolumbar fracture.Method：Thirty-one thoracolumbar fracture patients with complete clinical data and radiologic data（including X-ray films,CT and MRI） were enrolled.Six observers,who were orthopaedic surgeons,determined the classifications according to AO,Denis and TLICS systems respectively.The classification was repeated three months later.The Cohen Kappa test was used to determine inter-observer reliability and intra-observer reproducibility.Result：The average inter-observer Kappa values for AO,Denis and TLICS Systems were 0.517,0.639 and 0.713 respectively.And the intra-observer agreements were 0.766,0.832 and 0.804 respectively.Conclusion：Among the three classification systems,TLICS system has the greatest reliability and reproducibility,and thus has more value in clinical practice.