胸腰椎AO脊柱损伤评分和胸腰椎损伤分型及评分指导胸腰椎骨折手术的可信度和可重复性分析

Reliability and repeatability analysis of thoracolumbar AOSpine injury score and thoracolumbar injury severity score in guiding thoracolumbar fracture surgery

目的评价胸腰椎AO脊柱损伤评分(TLAOSIS)和胸腰椎损伤分型及评分系统(TLICS)在指导胸腰椎骨折手术的可信度和可重复性,探讨影响分型评分系统一致性的原因。方法选取6名医师,根据术前正侧位X线片、CT、MRI影像,分别用TLAOSIS和TLICS对2018年1月—2018年12月浙江中医药大学附属第二医院收治的55例胸腰椎骨折患者进行独立分型。对同一例患者,6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。4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。用加权Cohen\s Kappa系数从骨折形态、神经功能状态、后纵韧带复合体(PLC)损伤等方面评价观察者间可信度和观察者内可重复性,用Kappa系数观察各研究者内前后测量的一致性。结果两种分型评分系统均具有良好的可信度和可重复性。TLAOSIS:观察者间和观察者内对于骨折形态分型Kappa值分别为0.806和0.667;神经功能状态分型Kappa值分别为0.937和0.891;PLC损伤分型Kappa值分别为0.873和0.779;最终建议手术与否的Kappa值分别为0.816和0.764。TLICS:观察者间和观察者内对于骨折形态分型的Kappa值分别为0.878和0.788;神经功能状态分型Kappa值分别为0.936和0.888;PLC损伤分型Kappa值分别为0.809和0.691;最终建议手术与否Kappa值分别为0.811和0.705。两种分型评分系统在骨折形态和PLC损伤分型方面,无论是可信度分析还是可重复性分析方面,差异均具有统计学意义(P<0.05),但在神经功能评分方面,差异均无统计学意义(P>0.05)。结论TLAOSIS和TLICS在指导手术方面具有良好的一致性和可重复性,其中骨折形态和PLC损伤情况是影响两种分型评分系统对手术指导一致性的影响因素。

Objective To evaluate the reliability and repeatability of thoracolumbar AOSpine injury score(TLAOSIS)and thoracolumbar injury severity score(TLICS)classification scoring system in guiding thoracolumbar fracture surgery,and to explore the main reasons for the consistency of classification scoring systems.Methods Fifty-five thoracolumbar fracture patients with complete clinical data and radiologic data admitted to Second Affiliated Hospital of Zhejiang Chinese Medical University from January 2018 to December 2018 were enrolled.Based on their preoperative X-ray films,CT and MRI,six physicians were assigned to independently determine the classification using the TLAOSIS and TLICS.For the same patient,the classification was identified as inconsistency among 6 observers if there was an observer in a different type.After a 4-week interval,the 55 patients were presented in a random sequence to the same evaluators for repeated evaluation.All data did not contain any marks related to the type.The Cohen\s Kappa coefficient was used to determine the interobserver reliability and intraobserver repeatability concerning fracture morphology,posterior ligament classification(PLC)injury classification and neurological function score.Kappa coefficients were used to observe the consistency of pre-and post measure measurements within each observer.Results The two classification scoring systems had good consistency and reproducibility in guiding surgery.For TLAOSIS classification scoring system,the interobserver and intraobserver Kappa values for fracture morphology were 0.806 and 0.667;neurological status were 0.937 and 0.891;PLC injury classification were 0.873 and 0.779;the final recommendation surgery were 0.816 and 0.764.For TLICS classification scoring system,the interobserver and intraobserver Kappa values for fracture morphology were 0.878 and 0.788;neurological status were 0.936 and 0.888;PLC injury classification were 0.809 and 0.691;the final recommendation surgery were 0.811 and 0.705.The two classification scoring systems were statistically significant in fracture morphology and PLC injury classification both in the reliability and repeatability analysis(P<0.05),but there was no significant difference in the neurological function score(P>0.05).Conclusions TLAOSIS and TLICS have good consistency and reproducibility in guiding surgery.The fracture morphology and PLC injury classification are the factors influencing the consistency of surgical guidance for the two classification scoring systems.