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。

Interobserver reliability and intraobserver reproducibility assessment of two thoracolumbar fracture classification systems as used by multiple cliniciaus

Objective To investigate the reliability and reproducibility of the Denis and the thoracolumbar injury classification and severity score （TLICS） classification systems for thoracolumbar fracture as used by multiple clinicians. Methods Eighty-five patients with thoracolumbar fracture were retrospectively assessed by clinicians with different specialties （emergency surgeon, radiologist, orthopedic surgeon and rehabilitation physician） using both the Denis and TLICS classification systems. The cases were reordered and the observers repeated the exercise 2 months later. Kappa value was used to determine the interobserver reliability and intraobserver reproducibility. Results For the interobserver reliability, the Denis classification demonstrated substantial agreementr with an average Kappa value of 0.661 （range, 0.632 to 0.735）. The average Kappa for TLICS scores was 0.273（range, 0.217 to 0.316）. However, the reliability of TLICS management recommendation was substantial agreement, with an average Kappa value of 0.704 （range, 0.641 to 0.764）. For the intraobserver reproducibility, there was a moderate reliability when using the Denis classification（Kappa value = 0.459; range, 0.375 to 0.580）. The average Kappa value for TLCS scores and TLICS management recommendation was 0.380 （range, 0.319 to 0.478） and 0.724（range, 0.617 to 0.785）, respectively. Conclusion Denis classification is a reliable system for assessing thoracolumbar fractures when used by multiple Clinicians. However, TLICS management recommendation has better reliability and reproducibility, which should be helpful to communicate among clinicians and make treatment decisions.