新型胸腰椎骨折损伤AO分型系统的可信度和可重复性研究

Intraobserver and interobserver reliability of the New AOSpine Thoracolumbar Spine Injury Classification System

目的:评价新型胸腰椎骨折损伤AO分型系统的可信度和可重复性,探讨影响分型一致性的主要原因。方法:选取5名医师,根据术前正侧位X线片、CT、MRI影像,用新型AO分型系统独立对收治的70例胸腰椎骨折损伤患者进行分型。对同一例患者,5名医师在一次分型中只要有1名医师分型不同即认定为不一致。6周后,打乱资料顺序再次分型。全部资料均不含与分型有关的任何标记,应用加权Cohen′s Kappa系数(unweighted Cohen Kappa coefficients)评价观察者间可信度和观察者内可重复性。结果:新型AO分型系统的可信度Kappa系数为0.602,可重复性平均Kappa系数为0.782。在3大骨折类型中,压缩型(A型)和分离移位型(C型)损伤的判定具有中、高度的可信度和极好的可重复性,可信度Kappa系数分别为0.604、0.662,可重复性平均Kappa系数分别为0.787、0.761;牵张型损伤(B型)判定的一致性相对较差,可信度Kappa系数为0.362,可重复性平均Kappa系数为0.657。损伤各亚型整体一致性,可信度Kappa系数为0.526,可重复性平均Kappa系数为0.701;其中B2型一致性最差,可信度Kappa系数为0.214,可重复性平均Kappa系数为0.633;其次为A4型,可信度Kappa系数为0.322,可重复性平均Kappa系数为0.685。结论:新型胸腰椎骨折损伤AO分型系统具有中、高度的一致性和极好的可重复性,但对A4和B2型骨折判定的可信度较差。

Objectives： To evaluate the intraobserver and interobserver reliability and main influencing factors of the New AOSpine Thoracolumbar Spine Injury Classification System. Methods： Seventy thoracolumbar frac- ture patients with complete clinical data and radiologic data （including X-ray films, CT and MRI） were en- rolled. Five observers were assigned to independently determine the classifications according to the New AOSpine Thoracolumbar Spine Injury Classification System. If there was a observer in a different type, it was identified as inconsistent. After a 6-week interval, the 70 eases were presented in a random sequence to the same evaluators for repeated evaluation. The Cohen Kappa coefficient（K） was used to determine the interob- server and intraobserver reliability. Results： The New AOSpine Thoracolumbar Spine Injury Classification Sys- tem was found to have fair interobserver reliability and excellent intraobserver reliability. The interobsever and intraobsever reliability was Kappa=0.602 and Kappa=0.782, respeclively. The compression fracture（A type） and translation injury（C type） demonstrated fair interobserver reliability and excellent intraobserver reliability. The interobserver reliability was Kappa=0.604 and Kappa=0.662 respectively, while the intraobserver reliability was Kappa=0.787 and Kappa=0.761 respectively. The AO System had poor reliability in evaluation of the tension band injuries（B type）. The interobserver reliability was Kappa=0.362 and the intraobserver reliability was Kap- pa=0.657. The interobserver reliability of the overall subtypes was Kappa=0.526 and the intraobserver reliabil- ity was Kappa=0.701, in which the poorest reliability in evaluation was the subtype of B2. The interobserverreliability was Kappa=0.214 and the intraobserver reliability was Kappa=0.633. Followed was the subtype of A4. The interobserver reliability was Kappa=0.322 and the intraobserver reliability was Kappa=0.685. Conclusions： The new AOSpine Thoracolumbar Spine Injury Classification System has fair interobserver reliability and excellent intraobserver reliability. The poor reliabilities in evaluation of the subtypes A4 and B2 are the main reason for disagreement in this system.