强直性脊柱炎后凸畸形的301分型

The 301 operative classification for ankylosing spondylitis kyphosis

中文关键词:  强直性脊柱炎  后凸畸形  分型

英文关键词:Ankylosing spondylitis  Kyphosis  Classification

中文摘要:

  【摘要】 目的：建立强直性脊柱炎（ankylosing spondylitis，AS）后凸畸形新的分型方法———301分型，并对其可信度和可重复性进行检验分析。方法：根据后凸顶点位置不同将AS后凸畸形分为4种类型：腰椎型（Ⅰ型）、胸腰椎型（Ⅱ型）、胸椎型（Ⅲ型）及颈椎或颈胸交界型（Ⅳ型），除Ⅰ型外其他各型分为2个亚型：腰椎尚存在前凸为A亚型，腰椎出现后凸为B亚型。依据该分型方法对309例在我院接受脊柱截骨术治疗的AS后凸畸形患者进行分型，统计各型所占比例。由5位脊柱外科医生分别根据该分型标准对随机抽取的30例AS后凸畸形患者的影像资料进行分型，2周后此5位医生对打乱秩序的相同资料再次进行分型，收集分型结果，计算Kappa值检验一致性。结果：按照301分型方法将AS后凸畸形分为4型共7个亚型，309例患者中，Ⅰ型52例（16.8%）；Ⅱ型223例（72.2%），其中ⅡA型153例，ⅡB型70例；Ⅲ型33例（10.7%），其中ⅢA型25例，ⅢB型8例；Ⅳ型1例（0.3%），为ⅣB型。观察者间可信度为73.3%~86.7%，Kappa系数为0.761~0.847，可重复性为83.3%~93.3%，Kappa系数为0.821~0.925。结论：应用301分型方法对AS后凸畸形分型简单易行，其可信度和可重复性较好。

英文摘要:

  【Abstract】 Objectives: To design a new classification(301 operative classification) for ankylosing spondylistis(AS) kyphosis, and to identify the inter-observer and intra-observer reliability and repeatability. Methods: AS kyphosis was divided into 4 types according to the location of the apex: lumbar(type Ⅰ), thoracolumbar(type Ⅱ), thoracic (type Ⅲ), and cervical or cervicothoracic junction kyphosis(type Ⅳ), and each type except type Ⅰ has 2 subtypes: with lumbar lordosis(A) and with lumbar kyphosis(B). The total consecutive 309 patients suffering from AS kyphosis deformity undergoing a spinal osteotomy in our hospital were reviewed. The common type, each type′s frequencies were determined. Five spine surgeons independently assigned the curve type to 30 patients following the guidance described by new classification. The procedure was repeated two weeks later with the same patients presented in different order. Kappa value was used to determine the intra-observer and inter-observer repeatability and reliability. Results: There were 4 types and 7 subtypes for AS kyphosis according to 301 classification. Among the 309 patients, 52(16.8%) patients were type Ⅰ, 223(72.2%) type Ⅱ, 33(10.7%) type Ⅲ and 1(0.3%) type Ⅳ. The thoracolumbar type(type Ⅱ) was the most common. The inter-observer reliability testing was from 73.3% to 86.7%(Kappa coefficient was 0.761-0.847), while intra-observer repeatability was 83.3%-93.3%(Kappa coefficient was 0.821-0.925). Conclusions: This new classification system can be used easily and conveniently to classify AS kyphosis with good reliability and repeatability.