【作者】 郑新峰；

【导师】 盛伟斌；

【作者基本信息】 新疆医科大学 ， 骨科学， 2007， 硕士

【摘要】 目的:应用无标记的X线片评价特发性脊柱侧凸King、Lenke和PUMC分型的可信度和可重复性,为临床应用提供一定的参考。方法:四名骨科医师独立对56例患者的术前站立位全脊柱正、侧位和仰卧位左、右Bending位X线片进行测量并分型。通过计算平均百分比确定分型一致性,应用Kappa值判定可靠性和可重复性。结果:King分型具有极好的可重复性和中、高度的可信度。可重复性平均82.6%(Kappa值,0.767),可信度平均65.8%(Kappa值,0.542)。KingⅡ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KingⅤ型的判读。Lenke完整分型仅有较差的一致性,可重复性平均50.0%(Kappa值,0.438),可信度平均47.0%(Kappa值,0.402)。但Lenke分型各组成部分分别评价时,它们均取得了中、高度一致性。上胸弯是否结构性的判读以及矢状面修正型的分型是影响Lenke分型一致性的主要原因。PUMC三大型有极好的一致性,各亚型只有中、高度的一致性,可重复性平均74.1%(Kappa值,0.674),可信度平均70.2%(Kappa值,0.629)。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:三种分型均没有很好的解决上胸弯判读的争议,它仍然是影响三种分型一致性的重要原因。角度测量误差是导致Lenke和PUMC分型一致性较差的主要原因。临床工作中,应充分考虑到各种可能导致分型不一致的因素,在制定手术策略时应考虑到这些因素的影响。更多还原

【Abstract】 Objective: To determine the reliability and reproducibility of the King, Lenke and PUMC classification systems for idiopathic scoliosis using radiographs that had not been premeasured. Methods: Preoperative radiographs (standing full-length posteroanterior, lateral and two supine side-bending radiographs) of 56 patients were evaluated by four orthopedic surgeons independently on two separate occasions. The results were determined by calculating the average percentage of intraobserver and interobserver agreement. Reliability and reproducibility was quantified using kappa statistics. Results: The King classification demonstrated good to excellent intraobserver reproducibility and fair interobserver reliability. The mean interobserver reliability was 65.8% (mean Kappa coefficient, 0.542), while intraobserver reproducibility was 82.6% (mean Kappa coefficient, 0.767). The main reason of disagreement was distinguishment of the King type II and type III. Another reason is assessment of King type V. All three parameters of the overall Lenke curve classification demonstrated poor reliability. The mean interobserver reliability was 50.0% (mean Kappa coefficient, 0.438), while intraobserver reproducibility was 47.0% (mean Kappa coefficient, 0.402). The three parameters had fair interobserver reliabilities and intraobserver reproducibilities when it was examined separately. The main reasons for disagreement arose from judging a structural upper thoracic curve and from assigning of sagittal thoracic modifier. The PUMC type demonstrated good to excellent intraobserver reproducibility and interobserver reliability, and the subtype demonstrated fair. The mean interobserver reliability was 70.2% (mean Kappa coefficient, 0.629), while intraobserver reproducibility was 74.1% (mean Kappa coefficient, 0.674). The main reasons for disagreement were definition of a curvature and Cobb angle measurements. Conclusion: This three classifications do not appear to eliminate the dispute for the definition of the upper thoracic curve. The main reason of lower reliability and reproducibility of the Lenke and PUMC classification systems can be attribute to the variable of Cobb angle measurements. Orthopedic surgeons should be think over the effect of the factors mentioned above, when make the surgical decisions.更多还原