腰椎退变性滑脱临床与影像学分型的可信度与可重复性分析

Reliability and reproducibility analysis of clinical and radiographic degenerative spondylolisthesis classification

目的：探讨腰椎退变性滑脱临床与影像学（CARDS）分型的可信度与可重复性,分析其临床应用价值。方法：以CARDS分型为标准,由5位研究者对2010年1月-2013年12月在我院就诊的49例退变性腰椎滑脱患者进行独立分型,1个月后再次独立分型。收集结果,分别行不同观察者间可信度和同一观察者内可重复性分析,计算Kappa值与Spearman相关系数。结果：共计490例次分型中,包括A型74例次（15%）,B型167例次（34%）,C型187例次（38%）和D型62例次（13%）。5位研究者在第1次测试中对椎间隙高度、后凸畸形、滑脱距离及最终分型判断一致的百分比分别为77.6%-93.9%（89.6%）、69.4%-91.8%（86.6%）、67.3%-81.6%（77.5%）和65.3%-81.6%（74.1%）;可信度Kappa值分别为、0.764、0.719、0.596和0.641;Spearman相关系数分别为0.564、0.612、0.576和0.589。同一研究者前后两次测试中对椎间隙高度、后凸畸形、滑脱距离及最终分型判断一致的百分比分别为85.7%-98.0%（94.7%）、89.8%-95.9%（92.1%）、77.6%-91.8%（87.5%）和75.5%-87.8%（82.4%）;其可重复性Kappa值分别为0.857、0.842、0.779和0.804;Spearman相关系数分别为0.714、0.702、0.689和0.645。结论：CARDS分型应用于退变性腰椎滑脱患者具有较高的可信度与极佳的可重复性,值得临床推广应用。

Objectives： To investigate the inter-observer reliability and intra-observer reproducibility of the clinical and radiographic degenerative spondylolisthesis（CARDS） classification system for degenerative spondy- lolisthesis and its clinical values. Methods： From January 2010 to December 2013, 49 patients with degenerative spondylolisthesis were treated in our department. Based on the CARDS classification system, the radiographs were assessed by five observers independently on two separate occasions with an interval of 1 month. The inter-observer reliability and intra-observer reproducibility of the system were quantified by using Kappa value and Spearman correlation coefficient. Results： The total 490 classifications were evaluated for two times. Fifteen percent（74 cases） were described as type A; thirty-four percent（167 cases）, as type B; thirty-eight percent（187 cases）, as type C and thirteen percent（62 cases）, as type D. The inter-observer reliability assessed by the mean percentage and Kappa values at the first time was 77.6%-93.9%（89.6%）, 0.764 respectively for disc space; 69.4%-91.8%（86.6%）, 0.719 respectively for kyphosis; 67.3%-81.6%（77.5%）, 0.596 respectively for translation; 65.3%-81.6%（74.1%）, 0.641 respectively for final classification. The Spearman correlation coefficient was 0.564, 0.612, 0.576 and 0.589, respectively. The intra-observer reproducibility assessed by the mean percentage and Kappa values was 85.7%-98.0%（94.7%）, 0.857 respectively for disc space; 89.8% -95.9%（92.1%）, 0.842 respectively for kyphosis; 77.6%-91.8%（87.5%）, 0.779 respectively for translation;75.5%-87.8%（82.4%）, 0.804 respectively for final classification. The Spearman correlation coefficient was 0.714, 0.702, 0.689 and 0.645, respectively. Conclusions： The CARDS classification system for degenerative spondylolisthesis has good inter-observer reliability and excellent intra-observer reproducibility.