唇腭裂五码数字分类临床评价的初步研究

Clinical evaluation of the five-digit numerical recording system for classification of cleft lip and palate deformities

目的探讨临床评价唇腭裂五码数字分类的实用性。方法选择经过两课时唇腭裂五码数字分类培训的14名年轻医师，对200例未经治疗的唇腭裂患者照片进行分类诊断。诊断标准：以唇龈沟和切牙乳头（切牙孔）为标志将裂隙可能涉及的部位依次分为以下解剖部位：右（左）上唇、右（左）上颌牙槽突及原发腭、继发腭。每个解剖部位的裂隙程度分5个级别：0级：无裂隙；1级：隐裂；2级：裂隙〈1／2解剖部位；3级：裂隙〉1／2解剖部位；4级：完全性裂。以指导教师的诊断编码为依据，统计14名年轻医师的诊断总体符合率、各解剖部位裂隙程度诊断符合率，并统计裂隙部位类型。结果诊断总体符合率88％（2475／2800）。按裂隙部位及裂隙程度，4级唇裂和4级牙槽突裂诊断符合率较高，为99％（707／714）和100％（546／546），而2、3级的牙槽裂诊断符合率为70％（98／140）和82％（103／126）。在五码数字分类的17种裂隙部位类型中，本组病例中出现了14种类型。结论唇腭裂五码数字分类简明易懂，但当裂隙延伸至分级界线时可能出现判断偏差，需要进一步培训或优化裂隙程度分级。

Objective To evaluate the five-digit numerical recording system （LAPAL system） for classification of cleft lip and palate. Methods Fourteen young doctors took part in the study after receiving one-hour instruction twice for the LAPAL system. Photographs of 200 cases of untreated cleft lip and palate were used for the evaluation. The diagnostic codes of the patient were recorded and compared with the teacher＇s standard diagnosis. The basic criterion of the LAPAL system was that the clefts were arranged in five anatomical components in order of right lip （L） ,right alveolus and primary palate （A） ,secondary palate （P） ,left alveolus and primary palate （A） ,and left lip （L）. Tile degrees of the cleft severity were recorded with Arabic number 0 for the intact, 1 for the subcutaneous or submueous cleft,2 for clefts smaller than half of a component,3 for clefts larger than half of a component,4 for complete clefts. Results The rate of the diagnostic coincidence was 88% （2475/2800） totally. The higher coincidence appeared in degree 4 of cleft lip and in degree 4 of cleft alveolar and cleft primary palate as 99% （707/714） and 100% （546/546）, respectively. The lower coincidence appeared in degree 2 and degree 3 of clefts of the alveolus and primary palate as 70% （98/140） and 82% （103/126）, respectively. Among the 17 types of possible cleft combination, 14 types were found in the present study. Conclusions The LAPAL system is easily understood and grasped in a short time. Clefts on the border of adjoin degrees may cause confusion in diagnosis. More training or simplified modification is suggested.