BG Trauma Center, Eberhard-Karls-University, Schnarrenbergstr, 95, 72076 Tübingen, Germany.
Eur Spine J. 2010 Apr;19(4):558-66. doi: 10.1007/s00586-009-1231-2. Epub 2009 Dec 2.
Evaluation of the kyphosis angle in thoracic and lumbar burst fractures is often used to indicate surgical procedures. The kyphosis angle could be measured as vertebral, segmental and local kyphosis according to the method of Cobb. The vertebral, segmental and local kyphosis according to the method of Cobb were measured at 120 lateral X-rays and sagittal computed tomographies of 60 thoracic and 60 lumbar burst fractures by 3 independent observers on 2 separate occasions. Osteoporotic fractures were excluded. The intra- and interobserver reliability of these angles in X-ray and computed tomogram, using the intra class correlation coefficient (ICC) were evaluated. Highest reproducibility showed the segmental kyphosis followed by the vertebral kyphosis. For thoracic fractures segmental kyphosis shows in X-ray "excellent" inter- and intraobserver reliabilities (ICC 0.826, 0.802) and for lumbar fractures "good" to "excellent" inter- and intraobserver reliabilities (ICC = 0.790, 0.803). In computed tomography, the segmental kyphosis showed "excellent" inter- and intraobserver reliabilities (ICC = 0.824, 0.801) for thoracic and "excellent" inter- and intraobserver reliabilities (ICC = 0.874, 0.835) for the lumbar fractures. Regarding both diagnostic work ups (X-ray and computed tomography), significant differences were evaluated in interobserver reliabilities for vertebral kyphosis measured in lumbar fracture X-rays (p = 0.035) and interobserver reliabilities for local kyphosis, measured in thoracic fracture X-rays (p = 0.010). Regarding both fracture localizations (thoracic and lumbar fractures), significant differences could only be evaluated in interobserver reliabilities for the local kyphosis measured in computed tomographies (p = 0.045) and in intraobserver reliabilities for the vertebral kyphosis measured in X-rays (p = 0.024). "Good" to "excellent" inter- and intraobserver reliabilities for vertebral, segmental and local kyphosis in X-ray make these angles to a helpful tool, indicating surgical procedures. For the practical use in lateral X-ray, we emphasize the determination of the segmental kyphosis, because of the highest reproducibility of this angle. "Good" to "excellent" inter- and intraobserver reliabilities for these three angles could also be evaluated in computed tomographies. Therefore, also in computed tomography, the use of these three angles seems to be generally possible. For a direct correlation of the results in lateral X-ray and in computed tomography, further studies should be needed.
胸腰椎爆裂骨折的后凸角度评估常用于指导手术。后凸角度可根据 Cobb 法测量，分为椎体后凸角、节段后凸角和局部后凸角。本研究由 3 位观察者在 2 次不同时间，分别在 60 例胸腰椎爆裂骨折患者的侧位 X 线片和矢状位 CT 上测量 Cobb 法椎体后凸角、节段后凸角和局部后凸角。排除骨质疏松性骨折。使用组内相关系数（ICC）评估 X 线片和 CT 片上这些角度的观察者内和观察者间的可靠性。结果显示节段后凸角的重复性最高，其次是椎体后凸角。对于胸段骨折，节段后凸角在 X 线片上的观察者内和观察者间可靠性为“优秀”（ICC 0.826，0.802），在 CT 片上为“很好”到“优秀”（ICC=0.790，0.803）。对于腰椎骨折，在 CT 片上，节段后凸角的观察者内和观察者间可靠性为“优秀”（ICC=0.824，0.801），在 X 线片上为“很好”到“优秀”（ICC=0.790，0.803）。对于这两种影像学检查（X 线和 CT），观察者间可靠性差异有统计学意义的是腰椎骨折 X 线片上椎体后凸角（p=0.035）和胸椎骨折 X 线片上局部后凸角（p=0.010）。对于胸腰椎骨折，只有 CT 上的局部后凸角和 X 线片上的椎体后凸角的观察者间可靠性差异有统计学意义（p=0.045，p=0.024）。X 线片上椎体后凸角、节段后凸角和局部后凸角的观察者内和观察者间可靠性为“很好”到“优秀”，可作为手术指导的有用工具。对于侧位 X 线的实际应用，我们强调确定节段后凸角，因为该角度的重复性最高。CT 上这三个角度的观察者内和观察者间可靠性也可评价为“很好”到“优秀”。因此，这些角度在 CT 上的应用似乎也是可行的。为了使 X 线和 CT 的结果具有直接相关性，还需要进一步的研究。
