Qiu Guixing, Li Qiyi, Wang Yipeng, Yu Bin, Qian Jun, Yu Keyi, Lee Chia I, Zhang Jianguo, Shen Jianxiong, Zhao Yu, Weng Xisheng, Wang Ting, Aladin Darwesh M K, Lu Weijia William
Department of Orthopedics, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
Spine (Phila Pa 1976). 2008 Oct 15;33(22):E836-42. doi: 10.1097/BRS.0b013e318187bb10.
Comparison of 2 radiographic scoliosis classification systems by multiple surgeons.
Compare the reliability of Peking Union Medical College (PUMC) and Lenke scoliosis classification systems and analyze their differences.
The PUMC classification is a newly reported system based on radiographic measurements with recent popularity, while the Lenke classification is widely accepted worldwide in surgical design. Both these classification systems have their own individual characteristics, hence it is necessary to compare their reliability.
Five scoliosis surgeons independently evaluated and classified presurgical radiographs of 62 adolescent idiopathic scoliosis patients based on the PUMC and Lenke classification systems on 2 separate occasions. Radiographs were cleaned before each evaluation. Inter- and intraobserver reliabilities were quantified using Kappa statistics. Data were compared using chi2 analysis.
The PUMC classification's inter- and intraobserver percentage of agreement averaged to 91.0% (Kappa coefficient 0.896) and 90.2% (Kappa coefficient 0.892), respectively. While those of the Lenke curve type classification were 86.5% (Kappa coefficient 0.808) and 87.4% (Kappa coefficient 0.826). The PUMC classification from 10 individual measurements had 17 cases (27.4%) of disagreements, while in the Lenke curve type classification, 24 cases (38.7%) had disagreements. PUMC classification normally has discrepancies between type IIb, IIc, and IId, while Lenke classification has discrepancies in curve types 1 and 2. Out of 17 inconsistent PUMC curve type cases, 7 did not affect surgical fusion levels, while in the Lenke's only 2 out of 24 cases with discrepancies did not affect fusion range selection, with an obvious statistical difference.
The reliability of both PUMC classification and Lenke curve type classification were categorized as good-to-excellent. PUMC classification is relatively simple, with less confusion among inter- and intraobservers, with corresponding surgical fusion guidance and planning. The mismatch of curve classification had less influence on PUMC's fusion range selection than Lenke's.
多位外科医生对两种脊柱侧弯影像学分类系统的比较。
比较北京协和医学院（PUMC）和Lenke脊柱侧弯分类系统的可靠性，并分析它们的差异。
PUMC分类是一种新报道的基于影像学测量的系统，近来颇受关注，而Lenke分类在手术设计中在全球被广泛接受。这两种分类系统都有各自的特点，因此有必要比较它们的可靠性。
五位脊柱侧弯外科医生基于PUMC和Lenke分类系统，在两个不同场合独立评估并分类62例青少年特发性脊柱侧弯患者的术前X光片。每次评估前均对X光片进行清理。采用Kappa统计量对观察者间和观察者内的可靠性进行量化。使用卡方分析比较数据。
PUMC分类的观察者间和观察者内一致性百分比分别平均为91.0%（Kappa系数0.896）和90.2%（Kappa系数0.892）。而Lenke曲线类型分类的观察者间和观察者内一致性百分比分别为86.5%（Kappa系数0.808）和87.4%（Kappa系数0.826）。PUMC分类中10项单独测量中有17例（27.4%）存在分歧，而Lenke曲线类型分类中有24例（38.7%）存在分歧。PUMC分类在IIb型、IIc型和IId型之间通常存在差异，而Lenke分类在曲线类型1和2中存在差异。在17例PUMC曲线类型不一致的病例中，7例不影响手术融合节段，而在Lenke分类中，24例有差异的病例中只有2例不影响融合范围的选择，差异具有统计学意义。
PUMC分类和Lenke曲线类型分类的可靠性均为良好至优秀。PUMC分类相对简单，观察者间和观察者内混淆较少，具有相应的手术融合指导和规划。曲线分类的不匹配对PUMC融合范围选择的影响小于Lenke分类。
