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特发性脊柱侧凸King、Lenke和PUMC分型的可信度和可重复性
引用本文:盛伟斌,郑新峰,郭海龙,詹玉林,买尔旦,金格勒,甫拉提,盛军,邓强.特发性脊柱侧凸King、Lenke和PUMC分型的可信度和可重复性[J].中华医学杂志,2009,89(15).
作者姓名:盛伟斌  郑新峰  郭海龙  詹玉林  买尔旦  金格勒  甫拉提  盛军  邓强
作者单位:新疆医科大学第一附属医院脊柱外科,乌鲁木齐,830054
摘    要:目的 评价特发性脊柱侧凸King、Lenke和PUMC分型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 应用无标记的X线片对56例特发性脊柱侧凸患者的术前站立位全脊柱正、侧位和仰卧位Bending像进行测量并分型.两周后,打乱X线片排序再次测量并分型.所有x线片均不带与分型有关的任何测量标记.通过计算平均百分比确定分型一致率,应用Kappa值判定可信度和可重复性.结果 King分型具有中、高度的可信度和极好的可重复性.可信度平均65.8%(Kappa值0.542),可重复性平均82.6%(Kappa值0.767).King Ⅱ型和Ⅲ型侧凸判读是影响分型一致性最主要的原因.另一个重要的影响因素是King Ⅴ型的判读.Lenke分型的一致性较差,可信度平均47.0%(Kappa值0.402),可重复性平均50.0%(Kappa值0.438).各组成部分分别评价均有中、高度一致性.上胸弯是否为结构性以及矢状面修正型的判读是影响Lenke分型一致性的主要原因.PUMC分型有极好的一致性,可信度平均87.8%(Kappa值0.757),可重复性平均92.9%(Kappa值0.958).各亚型具有中、高度的一致性,可信度平均70.2%(Kappa值0.629),可重复性平均74.1%(Kappa值0.674).侧凸的限定以及Cobb角的测量误差是影响PUMC分型一致性的重要原因.结论 King分型和PUMC分型一致性高于Lenke分型.3种分型一致性受多种因素影响.其中,上胸弯判读,角度测量误差以及骶骨中线与侧凸顶点关系的判定是影响3种分型一致性的共同因素.

关 键 词:脊柱侧凸  分类法  诊断

Intraobserver and interobserver reliability of the King, Lenke,and PUMC classification systems for idiopathic scoliosis
SHENG Wei-bin,ZHENG Xin-feng,GUO Hai-long,ZHAN Yu-lin,MAI Er-dan,JIN Ge-le,PU La-ti,SHENG Jun,DENG Qiang.Intraobserver and interobserver reliability of the King, Lenke,and PUMC classification systems for idiopathic scoliosis[J].National Medical Journal of China,2009,89(15).
Authors:SHENG Wei-bin  ZHENG Xin-feng  GUO Hai-long  ZHAN Yu-lin  MAI Er-dan  JIN Ge-le  PU La-ti  SHENG Jun  DENG Qiang
Abstract:Objective To evaluate the intraobserver and interobserver reliability and main influencing factors of the King, Lenke, and PUMC classification systems for idiopathic scoliosis (IS) using radiographs that had not been premeasured. Methods Fifty-six patients with IS, 9 male and 47 female, aged 15.4 (11-18), underwent preoperative X-ray photography of spine standing full-length posteroanterior and lateral films and left and right supine side-bending radiographs. The films were read by four orthopedic surgeons independently to do measurement and typing according to the King, Lenke, and PUMC classification systems respectively. Two weeks later, the sequence of the X-ray films was re-ordered and the 4 surgeons read them and did measurement and typing once more. The average percentage of intraobserver and interobserver agreement was calculated. Kappa coefficients were used to determine the iutraobserver and interobserver reliability. Results King classification demonstrated fair intembserver reliability and excellent intranbserver reliability. The mean interobserver reliability was 65.8% (Kappa coefficient = 0.542), while the intraobserver reliability was 82.6% (Kappa coefficient =0.767). The main reason of disagreement was distinguishment of the King type Ⅱ and type Ⅲ. Another reason was assessment of King type Ⅴ. The complete Lenke classification demonstrated poor reliability. The mean interobserver reliability was 50.0%(Kappa coefficient = 0.438), and the intraobserver reliability was 47.0% (Kappa coefficient = 0.402).The 3 components of Lenke classification had fair interobserver and intraobserver reliability when they were examined separately. The main reasons for disagreement arose from judging whether there was a structural upper thoracic curve and assigning sagittal thoracic modifier. The PUMC type demonstrated excellent intraobserver and interubserver reliability with a mean interobserver reliability of 87.8% (Kappa coefficient =0.757), and a mean intraobserver reliability of 92.9% (Kappa coefficient = 0.958). Its subtypes demonstrated fair agreement with the mean interobserver reliability of 70.2% (Kappa coefficient =0.629), and a mean intraobserver reliability of 74.1% (Kappa coefficient =0.674). The main reasons for disagreement were definition of a curvature and Cobb angle measurement. Conclusion King and PUMC classification systems have higher interobserver and intraubserver reliability than Lenke classification. The reliability levels of the 3 classification systems are all influenced by many factors. Judgment of an upper thoracic curve, variable of Cobb angle measurement, and relationship of the central vertical sagittal line to apex of curve are the common reasons for disagreement in these 3 classifications.
Keywords:Scoliosis  Classification  Diagnosis
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