两种常用胸腰椎骨折分类系统的临床价值

目的探讨Denis和Gertzbein分类系统在胸腰椎骨折中的临床应用价值。方法40例急性胸腰椎骨折的X线片和CT提供给10位骨科医生,用Denis和Gertzbein两种分类方法进行分类。3个月后再分类。用Kappa(k)指数评价观察者间和观察者内的可信度。结果Denis四类型观察者间的平均Kappa(k)指数为0·588,16亚型为0·342;Gertzbein三类型为0·603,9亚型为0·420。Denis四类型观察者内的平均Kappa(k)指数为0·706,16个亚型为0·432;Gertzbein三类型为0·746,9亚型为0·511。结论Denis和Gertzbein分类系统都只呈中等程度的相符性和可重复性,都存在不同程度的缺陷。

Assessment of Clinical Application of Two Thoracic and Lumbar Spine Fracture Classification Systems

Objective To evaluate the application of Denis and Gertzbein systems in classification of thoracic and lumbar spine fractures.Methods The radiographic and computed tomography scan images of 40 patients with acute traumatic thoracic and lumbar spine fractures were classified by ten observers,all trained orthopaedic surgeons according to both the Denis and Gertzbein classification systems.Three months later,the classification was repeated.The Cohen Kappa (k) test was used for determining interobserver and intraobserver agreement.Results The average interobserver Kappa was 0.588 for the agreement regarding the assignment of the four Denis fracture types and 0.342 for the sixteen subtypes respectively while it was 0.603 for the agreement regarding the assignment of the three Gertzbein fracture types and 0.420 for the nine subtypes correspondingly.The intraobserver agreement was 0.706 and 0.746 for Denis and Gertzbein types,and 0.432 and 0.511,for the 16 Denis subtypes and 9 Gertzbein subtypes,respectively.Conclusion Both Denis and Gertzbein systems only have moderate realiability and repeatability with different degrees of defects.