国际脊柱畸形研究组推荐腰骶椎滑脱分型的可重复性与可信度研究

Interobserver and intraobserver reliability of the Spinal Deformity Study Group classification of lumbosacral spondylolisthesis

中文关键词:  腰骶椎滑脱  分型  国际脊柱畸形研究组  可信度  可重复性

英文关键词:Lumbosacral spondylolisthesis  Classification  Spinal Deformity Study Group  Reliability  Interobserver  Intraobserver

中文摘要:

  【摘要】 目的：评估国际脊柱畸形研究组（Spinal Deformity Study Group，SDSG）推荐的腰骶椎滑脱分型的可信度和可重复性。方法：对2001年1月~2010年1月期间我科收治的符合入选标准的53例发育性和峡部裂性腰骶椎滑脱患者的影像学资料进行回顾分析，其中男性12例，女性41例，年龄10~40岁（28.7±10.8岁），每例患者均有完整的术前站立正侧位X线片且均未进行预先测量。由4位脊柱外科医生分别根据SDSG分型标准进行分型，2周后此4位医生分别对这些患者的X线片再次进行分型，收集分型结果，分别作可信度和可重复性分析，计算Kappa值检验一致性。结果：4位医师对53例患者分型的可信度为71.7%~86.8%（Kappa值0.572~0.794），可重复性为83.0%~92.5%（Kappa值0.721~0.891）。滑脱轻、重度分级的可信度和可重复性分别为94.0%（Kappa值0.777）和96.7%（Kappa值0.862）。轻度滑脱患者中分型可信度为86.1%（Kappa值0.744），可重复性为86.6%（Kappa值0.751）；重度滑脱患者中分型可信度为83.3%（Kappa值0.693），可重复性为87.5%（Kappa值0.788）。结论：腰骶椎滑脱SDSG分型具有较高的可信度和可重复性，但其在指导手术策略制定中的应用价值尚需进行前瞻性研究进一步检验。

英文摘要:

  【Abstract】 Objectives: To evaluate the interobserver and intraobserver reliability of the Spinal Deformity Study Group(SDSG) classification for lumbosacral spondylolisthesis. Methods: All patients with lumbosacral developmental or acquried isthmic spondylolisthesis treated surgically in our clinic from 2001 to 2010 were identified and reviewed. Fifty-three patients met the inclusion criteria, including 12 males and 41 females with a mean age of 28.7 years(range, 10 to 40 years)． Pre-operative standing anteroposterior and lateral radiographs were taken in all patients and none of these radiographs had any premeasurements． The SDSG type for all subjects were determined by four spine surgeons independently． The procedure was repeated two weeks later in a different and randomly assigned order． Percentage of agreement and Kappa coefficients were used to determine the intraobserver and interobserver reliability. Results: Overall intra- and inter-observer agreements were 71.7%-86.8%(Kappa value 0.572-0.794) and 83.0%-92.5%(Kappa value 0.721-0.891), respectively. The intra-and inter-observer agreements and repeatability associated with slip grade were 94.0%(Kappa value 0.777) and 96.7%(Kappa 0.862), respectively. As for the determination of sacro-pelvic and spinal balance, intra- and inter observer agreements and repeatability were 86.1%(Kappa value 0.744) and 86.6%(Kappa value 0.751) for low-grade slips, while which were 83.3%(Kappa value 0.693) and 87.5%(Kappa value 0.788) for high-grade slips. Conclusions: SDSG classification has substantial intra-and inter-observer relia