胸腰段骨质疏松性骨折严重程度评分评估系统与骨质疏松性骨折分型的可重复性与可信度

Reproducibility and reliability of thoracolumbar osteoporotic fracture score assessment system and osteoporotic fractures classification

目的对比分析胸腰段骨质疏松性骨折严重程度评分评估系统(TLOFSAS)与骨质疏松性骨折(OF)分型评估胸腰椎骨质疏松性椎体压缩性骨折(OVCF)的可重复性与可信度。方法选取2017年8月—2019年5月于巴中市中心医院就诊的146例胸腰椎OVCF患者为研究对象。以TLOFSAS与OF分型为标准,由6位脊柱外科医师分别对每例患者的临床资料进行独立评价,2周后再次进行独立评价。收集评估结果,分别行观察者内可重复性及观察者间可信度分析,应用Kappa一致性检验分析TLOFSAS与OF分型的差异性。结果6位医师使用TLOFSAS共进行1752(146×6×2)次评估,其中<4分876次,4分582次,>4分294次;不同观察者间平均评分一致性为77.4%,平均可信度κ值为0.76,同一观察者内平均评分一致性为79.6%,平均可重复性κ值为0.786。6位医师使用OF分型共进行1752次评估,其中1型224次,2型694次,3型644次,4型154次,5型36次;不同观察者间平均评分一致性为84.3%,平均可信度κ值为0.79;同一观察者内平均评分一致性为85.2%,平均可重复性κ值为0.796。采取TLOFSAS评估的患者手术选择率(90.62%,58/64)高于OF分型(85.29%,58/68),但差异无统计学意义(P>0.05)。结论TLOFSAS与OF分型评估胸腰椎OVCF均具有较好的可重复性和可信度,值得临床推广应用。

Objective To compare and analyze the reproducibility and reliability of thoracolumbar osteoporotic fracture score assessment system(TLOFSAS)and osteoporotic fractures(OF)classification for thoracolumbar osteoporosis vertebral compression fracture(OVCF).Methods A total of 146 patients with thoracolumbar OVCF in Bazhong Central Hospital from August 2017 to may 2019 were selected as the research objects.Using the TLOFSAS and OF classification as criteria,the clinical data of each patient were independently evaluated by 6 spinal surgeons,respectively,and again after 2 weeks.The results were collected and analyzed for the same intra-observer reproducibility and differentinter-observer reliability,respectively.κvalues were applied to compare and analyze the differences between the 2 scoring methods.Results TLOFSAS was used to score for 1752(146×6×2)times,including 876 times less than 4 points,582 times equal to 4 points and 294 times more than 4 points.The mean score consistency rate of inter-observer was 77.4%with the mean reliabilityκvalue of 0.76;the mean score consistency rate of intra-observer was 79.6%with the mean reproducibilityκvalue of 0.786.Of the total 1752 times of the OF classification,224 type 1,694 type 2,644 type 3,154 type 4,and 36 type 5.The mean score consistency rate of inter-observer was 84.3%with a mean reliabilityκvalue of 0.79;the mean score consistency rate of intra-observer was 85.2%with a mean reproducibilityκvalue of 0.796.The operation selection rate of patients assessed by TLOFSAS(90.62%,58/64)was higher than that of OF classification(85.29%,58/68),but the difference was not statistically significant(P>0.05).Conclusion Both TLOFSAS and OF classification have good reliability and repeatability for thoracolumbar OVCF,which is worthy of wider clinical application.