Sheng Wei-Bin, Zheng Xin-Feng, Guo Hai-Long, Zhan Yu-Lin, Mai Er-Dan, Jin Ge-le, Pu La-Ti, Sheng Jun, Deng Qiang
Department of Spine, First Affiliated Hospital of Xinjiang Medical University, Urumuqi 830054, China.
Zhonghua Yi Xue Za Zhi. 2009 Apr 21;89(15):1047-52.
To evaluate the intraobserver and interobserver reliability and main influencing factors of the King, Lenke, and PUMC classification systems for idiopathic scoliosis (IS) using radiographs that had not been premeasured.
Fifty-six patients with IS, 9 male and 47 female, aged 15.4 (11 - 18), underwent preoperative X-ray photography of spine standing full-length posteroanterior and lateral films and left and right supine side-bending radiographs. The films were read by four orthopedic surgeons independently to do measurement and typing according to the King, Lenke, and PUMC classification systems respectively. Two weeks later, the sequence of the X-ray films was re-ordered and the 4 surgeons read them and did measurement and typing once more. The average percentage of intraobserver and interobserver agreement was calculated. Kappa coefficients were used to determine the intraobserver and interobserver reliability.
King classification demonstrated fair interobserver reliability and excellent intraobserver reliability. The mean interobserver reliability was 65.8% (Kappa coefficient = 0.542), while the intraobserver reliability was 82.6% (Kappa coefficient = 0.767). The main reason of disagreement was distinguishment of the King type II and type III. Another reason was assessment of King type V. The complete Lenke classification demonstrated poor reliability. The mean interobserver reliability was 50.0% (Kappa coefficient = 0.438), and the intraobserver reliability was 47.0% (Kappa coefficient = 0.402). The 3 components of Lenke classification had fair interobserver and intraobserver reliability when they were examined separately. The main reasons for disagreement arose from judging whether there was a structural upper thoracic curve and assigning sagittal thoracic modifier. The PUMC type demonstrated excellent intraobserver and interobserver reliability with a mean interobserver reliability of 87.8% (Kappa coefficient = 0.757), and a mean intraobserver reliability of 92.9% (Kappa coefficient = 0.958). Its subtypes demonstrated fair agreement with the mean interobserver reliability of 70.2% (Kappa coefficient = 0.629), and a mean intraobserver reliability of 74.1% (Kappa coefficient = 0.674). The main reasons for disagreement were definition of a curvature and Cobb angle measurement.
King and PUMC classification systems have higher interobserver and intraobserver reliability than Lenke classification. The reliability levels of the 3 classification systems are all influenced by many factors. Judgment of an upper thoracic curve, variable of Cobb angle measurement, and relationship of the central vertical sagittal line to apex of curve are the common reasons for disagreement in these 3 classifications.
使用未经预先测量的X线片，评估King、Lenke和PUMC特发性脊柱侧凸（IS）分类系统的观察者内和观察者间可靠性及主要影响因素。
56例IS患者，男9例，女47例，年龄15.4岁（11 - 18岁），术前行脊柱站立位全长正侧位X线片及左右卧位侧弯X线片拍摄。4名骨科医生独立阅片，分别根据King、Lenke和PUMC分类系统进行测量和分型。两周后，重新排列X线片顺序，4名医生再次阅片并进行测量和分型。计算观察者内和观察者间一致性的平均百分比。使用Kappa系数确定观察者内和观察者间的可靠性。
King分类系统显示观察者间可靠性一般，观察者内可靠性良好。观察者间可靠性平均为65.8%（Kappa系数 = 0.542），而观察者内可靠性为82.6%（Kappa系数 = 0.767）。不一致的主要原因是King II型和III型的区分，另一个原因是King V型的评估。完整的Lenke分类系统显示可靠性较差。观察者间可靠性平均为50.0%（Kappa系数 = 0.438），观察者内可靠性为47.0%（Kappa系数 = 0.402）。Lenke分类系统的3个组成部分分别检查时，观察者间和观察者内可靠性一般。不一致的主要原因是判断是否存在结构性上胸弯以及矢状面胸椎修正的分配。PUMC分型显示观察者间和观察者内可靠性良好，观察者间可靠性平均为87.8%（Kappa系数 = 0.757），观察者内可靠性平均为92.9%（Kappa系数 = 0.958）。其亚型一致性一般，观察者间可靠性平均为70.2%（Kappa系数 = 0.629），观察者内可靠性平均为74.1%（Kappa系数 = 0.674）。不一致的主要原因是弯曲的定义和Cobb角测量。
King和PUMC分类系统比Lenke分类系统具有更高的观察者间和观察者内可靠性。这3种分类系统的可靠性水平均受多种因素影响。上胸弯的判断、Cobb角测量的变化以及中央垂直矢状线与曲线顶点的关系是这3种分类中不一致的常见原因。
