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

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。     

下颈椎损伤分型评分系统的可信度及可重复性研究

目的 评价下颈椎损伤分型(SLIC)评分系统的可信度及可重复性. 方法 应用SLIC评分系统对2008年5月至2010年4月收治的54例下颈椎损伤患者的术前正侧位X线片、CT、MRI和体格检查等无标记的影像及病历资料进行分型并评判.4周后,打乱资料顺序再次分型并评判.全部资料均不带与分型和(或)评分有关的任何标记.通过计算平均百分比确定分型一致率,应用Kappa值、组内相关系数(ICC)判定可信度和可重复性. 结果 SLIC评分系统中损伤形态和神经功能状况评判有中、高度一致性,可信度平均分别为62.7％(Kappa=0.502,ICC=0.581)、69.7％ (Kappa=0.616,ICC =0.867),可重复性平均分别为71.8％(Kappa=0.631,ICC=0.746)、79.6％ (Kappa=0.735,ICC=0.871).椎间盘韧带复合体(DLC)损伤判定的一致性相对较差,可信度平均为55.8％(Kappa =0.317,ICC=0.483),可重复性平均为68.9％(Kappa=0.517,ICC=0.643).总分一致性的可信度平均为30.7％(Kappa=0.218,ICC=0.725),可重复性平均为44.5％(Kappa=0. 394,ICC=0.812).治疗选择的可信度平均为72.4％(Kappa=0.431,ICC=0.578),可重复性平均为78.8％(Kappa=0.581,ICC=0.759).结论 SLIC评分系统中损伤形态、神经功能状况及治疗选择的评判有较好的一致性.MRI对判定韧带损伤的不确定性是影响DLC损伤一致性评判的重要因素.     

2种胸腰椎骨折分型在不同专业医师中应用的可信度和可重复性研究

目的探讨胸腰椎骨折的Denis分型和胸腰椎损伤分类及严重程度评分（TLICS）分型系统在不同专业医师中应用的可信度和可重复性。方法分别由不同专科医师采用2种分型方法对85例胸腰椎骨折进行分类,间隔2个月后再次分型。分析2种分型的观察者间可信度和观察者内可重复性。结果按观察者间可信度,Denis分型的Kappa值在0．632～0．735,平均为0．661（基本可信）。TUCS分型具体分值的Kappa值在0．217～0．316,平均为0．273（轻中度可信）。TUCS的推荐治疗分类Kappa值在0．641～0．764,平均为0．704（基本可信）。按观察者内可重复性,Denis分型Kappa值在0．375—0．580,平均为0．459（中度可信）。TLICS分型具体分值的Kappa值在0．319～0．478,平均为0．380（轻中度可信）。TLICS的推荐治疗分类Kappa值在0．617～0．785,平均为0．724（基本可信）。结论胸腰椎骨折的Denis分型在各个专业医师中应用的可信度较好,仍有一定的临床价值。TLICS评分的推荐治疗分型在各个专业医师中的可信度与可重复性均更高,更有利于相互交流及指导治疗。     

脊柱侧凸胸椎椎弓根形态学分型系统的可信度与可重复性研究

【摘要】 目的：探讨脊柱侧凸胸椎椎弓根形态学分型系统在临床应用中的可信度与可重复性。方法：1998年1月~2009年1月手术治疗脊柱侧凸患者60例,术前均行胸椎CT扫描、椎弓根轴位薄层重建。根据椎弓根松质骨管腔的形态特征将脊柱侧凸胸椎椎弓根分为正常型、狭窄型、峡部硬化型、完全硬化型（包括凹陷硬化和平直硬化两个亚型）和缺如型。应用64排CT多层重建技术,测量、分析60例常见类型脊柱侧凸患者1440个胸椎椎弓根CT轴位扫描结果,由3位不了解本研究目的的脊柱外科高年资住院医师,在同一时间分别对1440个胸椎椎弓根CT轴位扫描结果进行分型。间隔1个月后,再次由这3位住院医师对这1440个椎弓根进行分型。应用Stata 10.0软件,运用多类别多评估者的Kappa分析方法进行统计学分析,评价观察者间的可信度及观察者内的可重复性。结果：3位医师之间首次分型结果相同的百分比分别为88%、84%、92%,可信度的Kappa系数分别为0.7647、0.6590、0.8292;同一医师前后两次分型结果相同的百分比分别为95%、97%、96%,可重复性的Kappa系数分别为0.9227、0.9513、0.9117。结论：脊柱侧凸胸椎椎弓根形态学分型系统具有中、高度的可信度和极好的可重复性。     

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

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.     

GATA脊柱结核分型的可信度与可重复性研究

目的:对GATA脊柱结核分型的可信度及可重复性进行分析,为临床应用提供参考。方法:让4名脊柱外科医师以GATA脊柱结核分型为标准独立对100例脊柱结核患者进行两次分型(间隔1个月),通过计算两两医师之间及同一医师前后两次分型对最后分型、各指标判断相同的平均百分比,确定分型一致性,应用Kap-pa值和Spearman系数判定其可信度和可重复性,当Kappa值>0.5时有中度或中度以上的一致性,Spearman相关系数值>0.40时有中度或中度以上正性相关。结果:4名医师对各指标(椎体塌陷、椎旁脓肿、脊柱稳定性、脊柱后凸畸形、矢状面指数、椎间盘破坏)及最后分型判断相同的平均百分比分别为61.92%、91.83%、63.33%、60.08%、78.25%、82.00%、52.33%;可信度的Kappa值分别为0.430、0.519、0.317、0.380、0.536、0.531、0.343;Spearman相关系数分别为0.392、0.526、0.392、0.503、0.569、0.582、0.576。同一医师前后两次对各指标(椎体塌陷、椎旁脓肿、脊柱稳定性、脊柱后凸畸形、矢状面指数、椎间盘破坏)及最后分型判断相同的平均百分比分别为72.75%、91.00%、85.25%、70.75%、88.75%、81.75%、73.00%;可重复性的Kappa值分别为0.574、0.453、0.627、0.523、0.724、0.584、0.591;Spearman相关系数分别为0.748、0.473、0.632、0.660、0.730、0.613、0.762。结论:GATA脊柱结核分型具有较高的可重复性,但可信度较差。     

Tomita及改良Tokuhashi结合脊柱肿瘤不稳评分在脊柱转移瘤患者治疗决策中的可信度和可重复性研究

目的 :分析Tomita评分结合脊柱肿瘤不稳评分(spinal instability neoplastic score,SINS)和改良Tokuhashi评分结合SINS评分用于脊柱转移瘤患者治疗决策的可信度和可重复性,评价两套评分系统临床运用价值。方法:3名具有一定临床经验的脊柱外科医生对41例脊柱转移瘤患者进行回顾性分析。这3名脊柱外科医生用Tomita评分、改良Tokuhashi评分、SINS评分对每位患者进行评分,并运用改良Tokuhashi结合SINS评分及Tomita结合SINS评分决定患者的治疗方案。间隔20天后对上述病例进行重复分析,分析观察者间一致性和观察者内一致性。结果:Tomita结合SINS评分用于治疗决策时,平均观察者间一致性Kappa值为0.78(0.75~0.81),平均观察者内一致性Cronbach′sα系数为0.79(0.77~0.82)。改良Tokuhashi结合SINS评分用于治疗决策时,平均观察者间一致性Kappa值为0.68(0.65~0.72),平均观察者内一致性Cronbach′sα系数为0.73(0.72~0.75)。有17.9%的患者在两组系统评估后而得出不同治疗方案。结论:Tomita结合SINS评分和改良Tokuhashi结合SINS评分均具有较好的可信度和可重复性。     

胫骨平台骨折AO、Schatzker和Hohl and Moore分型的可信度和可重复性比较及意义

目的比较研究胫骨平台骨折AO、Schatzker和Hohl and Moore分型的可信度和可重复性。方法 4名不同年资的观察者对60例胫骨平台骨折按这3种分型方法进行分型,8周后再对打乱顺序后同一组患者再次分型,通过Kappa值和分型一致平均百分比进行可信度和可重复性分析。结果不同观察者对AO、Schatzker和Hohl and Moore 3种分型可信度评估的Kappa值分别为0.502、0.675、0.391,最后分型判断一致平均百分比分别为70.6%、87.9%、56.3%。同一观察者前后两个阶段3种分型可重复性的Kappa值分别为0.807、0.926、0.739,最后分型判断一致平均百分比分别为89.1%、94.8%、82.1%。结论这3种分型方法均不是理想的分型系统,但Schatzker分型在可信度和可重复性上明显优于AO和Hohl and Moore分型,易于掌握,更适合指导胫骨平台骨折的治疗。但是目前需要创建更精确的评估方法对骨折分型进行综合、全面的评估。     

应用评分测量法评估青少年特发性脊柱侧凸患者的上胸弯

目的 设计脊柱侧凸(adolescent idiopathic scoliosis AIS)患者上胸弯评价量表,并应用其确定上胸弯是否需要融合.方法 由5名脊柱外科医师分别测量29份影像学资料.按照上胸弯冠状面Bending像、矢状面Cobb角和放射学双肩高度差(radiographic shoulder height,RSH)的不同,设定不同的分值(0～3分),设计评分量表.3周后,重复测量,分析量表的可靠性和可重复性.根据患者评分量表得分多少,确定是否需要融合上胸弯,分析此方法的可靠性和可重复性.结果 术前上胸弯冠状面Cobb角、Bending像Cobb角、RSH、矢状面Cobb角的平均得分分别为2.4、2.4、0.2和1.1,总计得分平均为6.0.评分量表的可信度和可重复性平均值分别为:总计得分项均为79.3%(Kappa值0.77);冠状面Cobb角得分项为89.7%(Kappa值0.89)和82.8%(Kappa值0.81);Bending像Cobb角得分项为86.2%(Kappa值0.85)和89.7%(Kappa值0.89);RSH得分项为96.6%(Kappa值0.95)和93.1%(Kappa值0.92);矢状面Cobb角得分项为96.6%(Kappa值0.95).根据评分量表,规定上述评分项单项得分达到3分或总计得分≥4分时,上胸弯需要融合,此方法的可信度和可重复性均为96.6%(Kappa值均为0.95).结论 AIS 上胸弯侧凸参数评分测量法和根据评分确定上胸弯是否需要融合方法可靠性和可重复性良好,可应用于临床.     

青少年特发性脊柱侧凸King、Lenke和PUMC(协和)分型的可信度和可重复性比较及意义

目的比较青少年特发性脊柱侧凸King、Lenke和PuMC（协和）分型系统的可信度和可重复性，探讨PUMC（协和）分型的临床应用价值。方法随机选取2002年1月至2004年12月手术治疗的100例青少年特发性脊柱侧凸病例，男22例，女78例；年龄1肌18岁，平均14．9岁。主弯Cobb角40°-75°，平均52°每例患者均有完整的术前X线片资料，包括术前站立位全脊柱正侧位及仰卧位左右Bending片和骨盆X线片，X线片均不进行预先测量。由4名有分型经验的脊柱外科医生分别进行脊柱侧凸的King、Lenke和PUMC（协和）分型，2周后再次进行分型，收集结果后对分型的可信度和可重复性进行分析。计算Kappa检验的一致性。结果King、Lenke、PUMC（协和）分型的可信度平均为81．2％（Kappa值=0．773）、60．5％（Kappa值=0。560）、8413％（Kappa值=0．819），可重复性平均为91．5％（Kappa值=0．897）、81．8％（Kappa值=0．796）、92％（Kappa值=0．907）。结论PUMC（协和）分型包括了脊柱侧凸在三平面内的畸形特点，分型全面，易于掌握，而且具有很好的可信度和可重复性，适合脊柱侧凸的三维矫形。     

肾结晶光镜观察评分法的可靠性研究

目的了解肾结晶光镜观察评分法的可靠性。方法从诱石模型大鼠肾脏HE染色切片库中,选取160张结晶程度不同的切片,由两人分别在×200光镜下观察肾结晶情况,按统一标准行结晶程度评分。比较两人的评分差异,并作一致性检验（加权Kappa、Kendall一致性系数）。1周后,其中一人对切片再次观察评分,比较两次评分的差异,检验其一致性。结果不同观察者评分的加权κ值为0.602 9,其对Ⅱ、Ⅲ、Ⅳ级结晶评分的κ值分别只有0.288 0、0.015 6、0.320 8;同一观察者两次评分的加权κ值为0.627 0,其Ⅱ、Ⅲ、级结晶评分的κ值分别只有0.050 5、0.075 6,一致性较差。结论结晶程度评分标准不够严密,造成观察者在光镜下对肾结晶分级的自由裁决度较大,导致评分的可靠性及一致性不够理想。     

AO-classification of thoracic and lumbar fractures—reproducibility utilizing radiographs and clinical information

This study was designed to assess the inter-observer reliability and intra-observer reproducibility of standard radiographic evaluation of 150 thoraco-lumbar fractures using the AO-classification. The influence of clinical information on agreement levels was also evaluated. Six observers (two junior and four senior residents) evaluated the radiographic images. The injuries were classified by each observer as either type A, B or C according to the AO-classification system and the levels of agreement were documented. After 3 months the injuries were again classified with the addition of the clinical findings of each patient and the level of agreement evaluated. The level of agreement was measured using Cohen’s κ-test. The overall inter-observer agreement was rated as fair (0.291) in the first session and moderate (0.403) in the second. Intra-observer values ranged from slight (0.181) to moderate (0.488). The increased level of agreement in the second session was attributed to the value of additional clinical information, the learning curve of the junior residents and the simplicity of the classification.     

Inter-observer reliability and intra-observer reproducibility of the Weber classification of ankle fractures

Our aim was to assess the reproducibility and the reliability of the Weber classification system for fractures of the ankle based on anteroposterior and lateral radiographs. Five observers with varying clinical experience reviewed 50 sets of blinded radiographs. The same observers reviewed the same radiographs again after an interval of four weeks. Inter- and intra-observer agreement was assessed based on the proportion of agreement and the values of the kappa coefficient. For inter-observer agreement, the mean kappa value was 0.61 (0.59 to 0.63) and the proportion of agreement was 78% (76% to 79%) and for intra-observer agreement the mean kappa value was 0.74 (0.39 to 0.86) with an 85% (60% to 93%) observed agreement. These results show that the Weber classification of fractures of the ankle based on two radiological views has substantial inter-observer reliability and intra-observer reproducibility.     

Intra- and inter-observer reliability of the novel vertebral bone quality score

Purpose

To assess the intra- and inter-observer reliability of the novel vertebral bone quality (VBQ) scoring system.

Methods

Four orthopedic surgery residents at various levels of training (PGY1-4) evaluated 100 noncontrast, T1-weighted MRIs of the lumbar spine. VBQ was calculated as quotient of the median of L1–L4 average signal intensity (SI) and the L3 cerebral spinal fluid (CSF) SI, as described by Ehresman et al. All measurements were repeated 2 weeks later. We performed a stratified analysis based on patient history of instrumentation, pathology, and MRI manufacturer/magnet strength to determine their effect on VBQ reliability. Spinal pathologies included compression fracture, burst fracture, vertebral osteomyelitis, epidural abscess, or neoplasm. The interclass correlation coefficient (ICC) two-way mixed model on absolute agreement was used to analyze inter-rater and intra-rater reliability. ICC less than 0.40 was considered poor, 0.40–0.59 as fair, 0.60–0.74 as good, and greater than 0.75 as excellent.

Results

Intra-observer reliability was excellent (≥ 0.75) for all four observers. When stratified by history of spinal instrumentation or spinal pathology, all raters showed excellent intra-observer reliability except one (0.71 and 0.69, respectively). When stratified by MRI manufacturer, intra-observer reliability was ≥ 0.75 for all raters.

Inter-observer reliability was excellent (0.91) and remained excellent (≥ 0.75) when stratified by history of spinal instrumentation, spinal pathology, or MRI-manufacturer.

Conclusions

VBQ scores from spine lumbar MRIs demonstrate excellent intra-observer and inter-observer reliability. These scores are reliably reproduced in patients regardless of previous instrumentation, spinal pathology, or MRI manufacturer/magnetic field strength.

     

The Inter-Observer and Intra-Observer Reliability of the Paprosky Femoral Bone Loss Classification System

The Paprosky classification provides a straightforward algorithm for defining bone loss and directing treatment for femoral revision. The purpose of this study was to test the inter-observer and intra-observer reliability of this system. Four arthroplasty surgeons reviewed radiographs of 205 consecutive femoral revisions. For each radiograph, the pattern of femoral bone loss was classified by Paprosky type on two separate occasions. A kappa value was used to calculate the reliability, which demonstrated an inter-observer reliability of 0.61, indicating substantial agreement between surgeons. The intra-observer reliability for each of the 4 participating surgeons was 0.81, 0.78, 0.76, and 0.75, indicating substantial to almost perfect agreement. There is substantial agreement among experienced arthroplasty surgeons when using the Paprosky Classification to characterize femoral bone loss.     

Bronchiolitis obliterans following lung transplantation: early detection using computed tomographic scanning

BACKGROUND: Computed tomographic (CT) scanning may enable earlier diagnosis of chronic lung allograft dysfunction than forced expiratory volume in 1 second (FEV1). A study was undertaken to determine intra-observer and inter-observer agreement of composite and air trapping CT scores, to examine the association of FEV1 with the composite and air trapping CT score, and to relate the baseline composite CT score to changes in FEV1 and changes in the composite CT score over 1 year. METHODS: Lung function and baseline CT scans following transplantation and at subsequent annual follow ups were analysed in 38 lung transplant recipients. Scans were randomly scored by two observers for bronchiectasis, mucus plugging, airway wall thickening, consolidation, mosaic pattern, and air trapping, and re-scored after 1 month. CT scores were expressed on a scale of 0-100 and correlated with FEV1 as a percentage of the post-transplant baseline value. RESULTS: The mean (SD) interval between baseline and follow up CT scans was 11.2 (4.7) months. Inter-observer and intra-observer agreement was good for both the composite and air trapping CT scores. There was a significant association between FEV1 and the composite CT score, with each unit of worsening in the baseline composite CT score predicting a 1.55% and 1.37% worsening in FEV1 over the following year (p<0.0001) and a 1.25 and 1.12 unit worsening in the composite CT score (p<0.0001) for observers 1 and 2, respectively. CONCLUSION: These findings indicate a potential role for a composite CT scoring system in the early detection of bronchiolitis obliterans.     

Head-at-risk signs in Legg-Calvé-Perthes disease: poor inter- and intra-observer reliability

BACKGROUND: The head-at-risk signs are used as prognostic indicators in Legg-Calvé-Perthes disease. These signs have been assessed only once regarding inter-observer reliability, however. Intra-observer reliability seems not to have been studied to date. METHOD: 76 anteroposterior pelvic radiographs of unilateral Legg-Calvé-Perthes disease were assessed by 5 observers on 2 occasions, in order to assess the inter- and intra-observer reliability in identifying head-at-risk signs. The observers included 1 consultant pediatric orthopaedic surgeon, 1 consultant radiologist, 2 specialist registrars and 1 senior house officer. Inter- and intra-observer reliabilities were assessed using the kappa coefficient. RESULTS: The intra-observer reliability was good for lateral subluxation and metaphyseal cystic changes, moderate for lateral calcification, and fair for Gage's sign and horizontal growth plate. The inter-observer reliability was moderate for lateral subluxation, fair for lateral calcification and metaphyseal cystic changes, and slight for Gage's sign and horizontal growth plate. INTERPRETATION: There was considerable variation in the diagnosis of the head-at-risk signs between observers. This makes the classification difficult to use in clinical practice.     

Head-at-risk signs in Legg-Calvé-Perthes disease: Poor inter- and intra-observer reliability

Background?The head-at-risk signs are used as prognostic indicators in Legg-Calvé-Perthes disease. These signs have been assessed only once regarding inter-observer reliability, however. Intra-observer reliability seems not to have been studied to date.

Method?76 anteroposterior pelvic radiographs of unilateral Legg-Calvé-Perthes disease were assessed by 5 observers on 2 occasions, in order to assess the inter- and intra-observer reliability in identifying head-at-risk signs. The observers included 1 consultant pediatric orthopaedic surgeon, 1 consultant radiologist, 2 specialist registrars and 1 senior house officer. Inter- and intra-observer reliabilities were assessed using the kappa coefficient.

Results?The intra-observer reliability was good for lateral subluxation and metaphyseal cystic changes, moderate for lateral calcification, and fair for Gage's sign and horizontal growth plate. The inter-observer reliability was moderate for lateral subluxation, fair for lateral calcification and metaphyseal cystic changes, and slight for Gage's sign and horizontal growth plate.

Interpretation?There was considerable variation in the diagnosis of the head-at-risk signs between observers. This makes the classification difficult to use in clinical practice.     

下颈椎损伤分型临床应用的可靠性与有效性的评价

目的 评价脊柱创伤研究小组(STSG)提出的下颈椎损伤分型(SLIC)临床应用的可靠性和有效性。方法 选取2006年6月至2009年6月收治的30例下颈椎外伤患者,其中男24例,女6例;年龄31 ～74岁,平均54.4岁。损伤节段：C3/42例,C4/56例,C5/67例,C6/74例,C3-53例,C4-66例,C3-62例。30例患者中8例行非手术治疗,22例行手术治疗。根据SLIC系统进行评分,该系统主要以损伤形态、椎间盘韧带复合体(DLC)的完整性及神经功能状态3个成分为基础。使用组间相关系数(ICC)评价SLIC临床应用的可靠性,使用Cohen's Kappa评价SLIC指导治疗的有效性。结果 损伤形态观察者间信度优(ICC =0.68),DLC完整性观察者间信度良好(ICC =0.51),神经功能状态观察者间信度特优(ICC=0.83),SLIC总得分观察者间信度优(ICC=0.78)。SLIC推荐治疗方案和实际治疗方案达到86.7％的一致性(Kappa =0.706)。若排除得分3～5分的患者,SLIC推荐治疗方案和实际治疗方案达到92.9％的一致性(Kappa =0.837)。结论 SLIC简单、标准、可靠性强,能有效地指导临床治疗。