退变性腰椎滑脱French分型和CARDS分型的可重复性与可信度研究

Reproducibility and reliability analysis of French and CARDS classification in degenerative spondylolisthesis

中文关键词:  退变性滑脱  French分型  CARDS分型  可信度  可重复性

英文关键词:Degenerative spondylolisthesis  French classification  CARDS classification  Reliability  Repeatability

中文摘要:

  【摘要】 目的：对退变性腰椎滑脱的French分型及CARDS分型进行可重复性与可信度的对比分析，探讨两种分型在退变性腰椎滑脱患者中的应用价值。方法：回顾性分析2012年1月～2016年6月期间118例腰椎退变性滑脱（L4/5 91例、L5/S1 27例）患者，其中男性26例，女性92例，平均年龄61.1±8.1岁。3名脊柱外科医师对患者术前X线片独自进行两次测量，分别使用French分型和临床与影像学分型（clinical and radiographic degenerative spondylolisthesis，CARDS分型）进行评估和分型，收集结果，作同一观察者间可重复性及不同观察者间可信度分析。应用Kappa值比较分析两种分型的差异性。结果：3位观察者使用French分型系统共进行708次（118例×3×2次）分型，包括1型261次，2型107次，3型83次，4型54次，5型203次，观察者内分型一致率80.5%～86.4%（Kappa值0.740～0.815），属于“基本可信”；观察者间分型一致率为79.7%～82.2%（Kappa值0.728～0.758），属于“基本可信”。测量并分型单个患者平均花费时间约138s。CARDS分型系统共708次分型中，包括A型（A1）19次，B型（B1 90次，B2 59次）149次，C型（C1 291次，C2 108次）399次，D型（D1 98次，D2 43次）141次，观察者内总体一致率90.7%～93.2%（Kappa值0.878～0.911），属于“完全可信”；观察者间总体一致率88.1%～94.1%（Kappa值0.844～0.921），属于“完全可信”。测量并分型单个患者平均花费时间约67s。结论：两种分型系统具有较高的可重复性与可信度，CARDS分型可信度与可重复性优于French分型。

英文摘要:

  【Abstract】 Objectives: To compare the reproducibility and reliability of the French classification and the CARDS classification for degenerative spondylolisthesis(DS), and to compare the clinical values of these two classifications. Methods: One hundred and eighteen L4/5 or L5/S1 DS patients treated surgically from January 2012 to June 2016 were retrospectively analyzed. There were 26 males and 92 females, among whom the average age was 61.1±8.1 years. Three spine surgeons independently and separately measured the preoperative X-rays. The intra-observer reproducibility and inter-observer reliability were analyzed. The Kappa value was calculated to compare the difference between the two classifications. Results: A total of 708 measurements were performed by the 3 surgeons for each classification. In French classification, 261 cases were described as type 1, 107 cases as type 2, 83 cases as type 3, 54 cases as type 4 and 203 cases as type 5. The intra- and inter-observer agreements were 80.5%-86.4%(Kappa value, 0.740-0.815) and 79.7%-82.2%(Kappa value, 0.728-0.758), respectively. The mean time spent on classification for a single case was about 138 seconds. In CARDS classification, 19 cases were classified into type A(A1), 149 cases into type B (90 cases in type B1, 59 cases in type B2), 399 cases into type C(291 cases in type C1, 108 cases in type C2), and 141 cases into type D (98 cases in type D1, 43 cases in type D2). The intra- and inter-observer agreements were 90.7%-93.2% (Kappa value, 0.878-0.911) and 88.1%-94.1% (Kappa value, 0.844-0.921), respectively. The mean time spent on classification for a single case was about 67 seconds. Conclusions: The two classifications have satisfying intra-observer reproducibility and inter-observer reliability for degenerative spondylolisthesis patients. CARDS classification′s reliability and repeatability are better than those of French.