基于站立位全脊柱X线片判定退变性腰椎侧凸上端椎、中立椎、稳定椎的一致性验证

Consistency validation of the determination of the upper end,neutral,and stable vertebrae of degenerative lumbar scoliosis by upright long-cassette radiographs

目的探讨在退变性腰椎侧凸(DLS)患者站立位全脊柱X线片上不同观察者对主弯上端椎、中立椎和稳定椎评估结果的一致性和一致率。方法横断面研究。纳入2021年1月—2022年10月河北医科大学第三医院脊柱外科行手术治疗的70例DLS患者的临床资料,其中男26例、女44例,年龄51~78(61.5±8.1)岁。由脊柱外科副主任医师(观察者1)、主治医师(观察者2)、住院医师(观察者3)各1位分别对70例患者的站立位脊柱全长正位X线片中腰椎主弯的上端椎、中立椎和稳定椎进行判定,每位观察者判定2次,2次判定间隔2 d。观察者间一致性检验以第1次判定结果为准。记录3位医师判断DLS患者腰椎主弯的上端椎、中立椎和稳定椎的判定结果及一致率。采用Cohen’s Kappa相关系数评价3位观察者内判断结果的一致性,采用Fleiss’s Kappa相关系数评价观察者之间判断结果的一致性。观察者内判定结果一致率为前后2次判定完全一致的百分比,观察者间一致率为3位观察者判定结果完全一致的百分比。结果观察者内判定上端椎、中立椎和稳定椎的一致性:观察者1的Kappa值分别为0.766、0.807和0.837,一致率分别为87.1%、90.1%和92.9%;观察者2的Kappa值分别为0.733、0.701和0.727,一致率分别为87.1%、84.3%和88.5%;观察者3的Kappa值分别为0.661、0.639和0.671,一致率分别为82.5%、81.4%和81.4%。3位观察者内判定上端椎的一致性均为良好;判定中立椎、稳定椎,观察者1均为优秀,观察者2、观察者3均为良好。观察者内判定上端椎、中立椎、稳定椎的一致率由高到低均依次为观察者1>观察者2>观察者3。观察者间判定上端椎、中立椎和稳定椎的一致性:Kappa值分别为0.448、0.200和0.353,一致率分别为58.6%、38.6%和54.3%。观察者间判定上端椎一致性一般,稳定椎一致性较差,中立椎一致性差;判定上端椎、中立椎、稳定椎的一致率由高到低均依次为上端椎>稳定椎>中立椎。结论在站立位全脊柱X线片上判定DLS患者腰椎主弯上端椎、中立椎和稳定椎,观察者内判定的一致性均较好,一致率均较高;而观察者间判定的一致性和一致率均不理想,可能与不同观察者的经验、水平不同有关。

Objective This study aimed to investigate the concordance and agreement rates in determining the upper end,neutral,and stable vertebrae on standing full-spine radiographs in patients with degenerative lumbar scoliosis(DLS).Methods The retrospective cross-sectional study was conducted.Clinical data of 70 patients with DLS who underwent surgical treatment in the Department of Spine Surgery in the Third Hospital of Hebei Medical University from January 2021 to October 2022 were included in this study,including 26 males and 44 females,aged 51-78(61.5±8.1)years.The spine surgery deputy chief physician(observer 1),attending physician(observer 2),and resident physician(observer 3)judged the upper end,neutral,and stable vertebrae of the main bend in the standing full-length orthopantomogram of the spine in 70 patients,respectively.Each observer made two judgments,with an interval of 2 days.The interobserver agreement test was based on the results of the first judgment to determine.The results and consistency rate of the three physicians in judging the upper,neutral,and stable vertebrae of the lumbar main curvature in patients with DLS were recorded.Cohen's Kappa correlation coefficient was used to evaluate the intraobserver agreement among the three observers,and Fleiss's Kappa correlation coefficient was used to evaluate the interobserver agreement.The intraobserver agreement rate was the percentage of the observer’s own judgments that agreed exactly on two occasions.The interobserver agreement rate is the percentage of three observers who agree that the results are identical.Results The intraobserver consistency results for the upper end,neutral,and stable vertebrae were as follows:the Kappa values for observer 1 were 0.766,0.807,and 0.837,with agreement rates of 87.1%,90.1%,and 92.9%,respectively;the Kappa values for observer 2 were 0.733,0.701,and 0.727,with agreement rates of 87.1%,84.3%,and 88.5%,respectively;the Kappa values for observer 3 were 0.661,0.639,and 0.671,with agreement rates of 82.5%,81.4%,and 81.4%,respectively.The consistency of the upper end vertebra was good among all 3 observers.To determine the neutral and stable vertebrae,observer 1 was excellent,observer 2 and observer 3 were good.The consistency rates of upper,neutral,and stable vertebrae among the intraobserver were judged to be observer 1>observer 2>observer 3 from high to low.The Kappa values for determining the consistency of upper,neutral,and stable vertebrae among the interobserver were 0.448,0.200,and 0.353,respectively,and the consistency rates were 58.6%,38.6%,and 54.3%,respectively.The consistency of upper end vertebrae was general among observers,the consistency of stable vertebrae was poor,and the consistency of neutral vertebrae was poor.The consistency rate of the upper end,neutral and stable vertebrae was determined to be the upper end vertebra>stable vertebra>neutral vertebrae from high to low.Conclusion The upper,neutral,and stable vertebrae of the lumbar main curvature of patients with DLS are determined on the standing spine X-ray,and the internal consistency of the intraobserver is good.In addition,the consistency rate is high.However,the consistency and consistency rate of interobserver judgment are not ideal,which may be due to the different experience and level of interobserver.