医师训练水平对青少年特发性脊柱侧凸 PUMC 分型可信度的影响

目的：评价不同训练水平的医师对特发性脊柱侧凸PUMC分型可信度的影响。方法：3名具有不同特发性脊柱侧凸诊治经验的医师对80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像进行两次测量并分型，两次间隔2周。计算平均百分比确定分型一致率，应用Kappa值判定可信度。结果：PUMC分型的3大型观察者自身前后一致性和观察者之间一致性极佳。 PUMC分型的13个亚型，3名观察者自身前后一致性和观察者之间一致性均为良好到极佳。观察者1自身前后分型一致性最差（Kappa值为0．738），观察者2其次（Kappa值为0．770），观察者3最好（Kappa值为0．903）。观察者之间一致性结果提示观察者2 vs 3一致性最好（Kappa值为0．770）；观察者1 vs 2和观察者1 vs 3分型一致性结果接近（Kappa值分别为0．739和0．737）。结论：PUMC三大型以及亚型的分型一致性均较好，医师训练水平在一定程度上影响PUMC分型的一致性。

Level of Professional Training for Interobserver and Intraobserver Agreement of PUMC Classifications for Idiopathic Scoliosis

Objective：To determine whether the level of professional training would affect reliability of PUMC classification for adolescent idiopathic scoliosis .Methods：Examinations of preoperative radiographs （ standing full-length posteroanterior , lateral and two supine side -bending radiographs ） of 80 cases were per-formed by 3 orthopedic surgeons with a completely different degree of professional training according to PUMC ’ s criteria twice at the interval of two weeks .Kappa statistics were used to determine intraobserver and interob-server agreement .Results：The PUMC type demonstrated excellent intraobserver and interobserver reliability . While the subtype demonstrated good to excellent intraobserver and interobserver agreement .Among them, the intraobserver agreement for Observer 1 was the lowest with kappa coefficients of 0.738, while the intraobserver agreement for Observer 3 was the highest with kappa coefficients of 0.903.The intraobserver agreement was middle with kappa coefficients of 0.770.A maximum kappa coefficient of 0.770 for the pair of Observer 2 and Observer 3 was determined and 0.739 and 0.737 for the other two pairs of observers were shown .Conclusions：The results confirm that both PUMC type and subtype have a good reliability .The degree of professional training seems to influence the reliability of PUMC classification .