简化骨龄评分和拇指骨骺评分在青少年特发性脊柱侧凸骨龄评分中的可信度与可重复性比较

Reliability and repeatability analysis of simplified skeletal maturity scoring and thumb ossification composite index in the assessment of skeletal maturity inadolescent idiopathic scoliosis

目的对比分析青少年特发性脊柱侧凸（AIS）的简化骨龄评分系统（SSMS）和拇指骨骺评分（TOCI）的可信度与可重复性，比较两种评分在AIS患者中的应用价值。方法选取2006年10月至2013年8月于南京鼓楼医院门诊就诊的500例女性AIS患者为研究对象并随机抽取每例患者的1次随访。以SSMS评分和TOCI评分为标准，由三位脊柱外科医师分别对患者每次随访的左手掌正位片进行独立评分，两周后再次进行独立评分。收集结果，分别行不同观察者间可信度及同一观察者内可重复性分析。应用Kappa值比较分析两种评分方法的差异性。结果三位医师使用SSMS评分共进行3000次（500×3×2次）评分，包括1级50次，2级258次，3级962次，4级340次，5级315次，6级304次，7级589次，8级182次；观察者间可信度为76．8％～82．0％，Kappa值0．716～0．778；观察者内可重复性为75．8％～82．4％，Kappa值0．705～0．782。TOCI评分共计3000次评分中，包括1级27次，2级183次，3级167次，4级171次，5级745次，6级536次，7级410次，8级761次；观察者间评分一致率为91．6％～92．4％，Kappa值0．897～0．907；观察者内评分一致率为90．4％～92．0％，Kappa值0．882～0．902。结论SSMS评分与TOCI评分均具有较高的可信度与可重复性，后者具有更高的可靠性，因此值得临床推广应用。

Objective To compare the reliability and repeatability of simplified skeletal maturity scoring （SSMS） and thumb ossification composite index （TOC1） in the assessment of skeletal maturity in adolescent idiopathic scoliosis （AIS） and their clinical utilization. Methods A review was conducted on 500 AIS patients treated between October 2006 and August 2013 in Nanjing Drum Tower Hospital and one follow- up of each patient was randomly selected for this study. Based on SSMS and TOCI, the radiographs of the left palm were assessed by three observers independently with an interval of 2 weeks. The inter-observer reliability and intra-observer repeatability of two methods were analyzed by using Kappa value. Results A total of 3 000 measurements were performed by the 3 surgeons for each method. For SSMS, 50 eases were described as stage 1 258 cases as stage 2 962 cases as stage 3 340 cases as stage 4 315 cases as stage 5 304 cases as stage 6 589 cases as stage 7 and 182 cases as stage 8. The inter-observer and intra-observer agreements was 76. 8% - 82. 0% （ Kappa value 0. 716 - 0. 778 ） and 75.8% - 82.4% （ Kappa value 0. 705 -0. 782） , respectively. For TOCI, 27 cases were described as stage 1 183 eases as stage 2 167 cases as stage 3 171 cases as stage 4 745 eases as stage 5 536 cases as stage 6 410 cases as stage 7 and 761 cases as stage 8. The inter-observer and intra-observer agreements was 91.6% - 92. 4% （ Kappa value 0. 897 -0. 907 ） and 90. 4% - 92. 0% （Kappa value 0. 882 - 0. 902）, respectively. Conclusions The two methods of SSMS and TOCI have substantial inter-observer reliability and intra-observer reproducibility for the assessment of skeletal maturity in AIS. TOCI has relatively higher reliability and repeatability when compared with SSMS.