慢性症状性骨质疏松性胸腰椎骨折的影像学分型及其信度检验

目的]针对慢性症状性骨质疏松性胸腰椎骨折(chronic symptomatic osteoporotic thoracolumbar fracture,CSOTF),本研究提出了一种全新的基于骨折影像学特点的分型体系,并对其可信度进行了检验。方法]回顾性分析2010年1月~2017年6月本院收治的368例具有完整影像资料的CSOFT患者,影像学检查包括腰椎正侧位及过屈过伸位X线片、CT和MRI。根据影像学上伤椎是否存在失稳、椎管是否合并狭窄和有无后凸畸形三个关键特征,将CSOTF分为I型(动态稳定型)、II型(动态不稳型)、III型(椎管狭窄型)、IV型(后凸畸形型),V型(混合型)。随机抽取40例患者,由10名医生按照上述分型体系对患者进行分型评估,并在初次评估1个月后再进行第二次评估,计算测量者间信度(interobserver reliability)与测量者内信度(intraobserver reliability)。结果]在368例CSOTF患者中,I型最多,占55.71%;V型最少,占5.99%。对40例CSOTF患者的分型评估,测量者间可信度的总体κ值为0.834,表明CSOTF影像学分型一致性好;测量者内可信度的总体κ值为0.853,表明两轮评估的重复性好。结论]本研究表明CSOFT影像学分型,分类简单,一致性与重复性好,有利于临床评估与信息沟通。

Reliability of a novel radiographic classification system for chronic symptomatic osteoporotic thoracolumbar fracture

Objective]To develop a novel classification system for chronic symptomatic osteoporotic thoracolumbar frac⁃ture(CSOTF)based on the fractures radiographic characteristics,and verify its reliability.Methods]A retrospective study was conducted on 368 patients who visited our hospital from January 2010 to June 2017,and were definitively diagnosed as CSOTF with complete imaging data,including dynamic radiographs,computed tomography scans and magnetic resonance images.A novel classification system for CSOTF was developed by us based on 3 key image characteristics,such as whether or not the af⁃fected segment lost stability,accompanied with spinal stenosis,or accompanied with kyphotic deformity,which divided the CSOTF into 5 types,including the Type I(the dynamic stability type),Type II(the dynamic instability type),Type III(the spi⁃nal stenosis type),Type IV(the kyphosis type),and Type V(the mixed type).Ten observers graded the image data of 40 pa⁃tients twice 2 months apart by using this classification system after systematically learning.The Kappa coefficients(κ)were cal⁃culated to determine intraobserver and interobserver reliability.Results]Among the 368 patients with CSOTF,the Type I was the most common,accounting for 55.71%of all patients,while the Type V was the least,accounting for 5.99%of all patients.In term of reliability test in 40 cases of CSOTF patients,the total kappa value of interobserver reliability was of 0.834,indicating a good consistency,while the total kappa value of intraobserver reliability was of 0.853,indicating that a satisfactory repeatability of the new-developed classification system.Conclusion]This novel radiographic classification system for CSOFT is easily grasped by clinicians with high consistency and repeatability,and facilitates clinical evaluation and information communication.