Patel Alpesh A, Whang Peter G, Brodke Darrel S, Agarwal Amit, Hong Joseph, Fernandez Carmella, Vaccaro Alexander R
University of Utah, Departments of Orthopaedic Surgery and Neurosurgery, Salt Lake City, Utah, USA.
Indian J Orthop. 2007 Oct;41(4):322-6. doi: 10.4103/0019-5413.36995.
Despite numerous attempts at classifying thoracolumbar spinal injuries, there remains no consensus on a single unifying algorithm of management. The ideal system should provide diagnostic and prognostic information, exhibit adequate reliability and validity and be easily applicable to clinical practice. The purpose of this study is to assess the reliability and validity of two novel classification systems for thoracolumbar fractures - the Thoracolumbar Injury Severity Score (TLISS) and the Thoracolumbar Injury Classification and Severity Score (TLICS) - and also to discuss potential efforts towards research in the future. MATEREIALS AND METHODS: Seventy-one patients with thoracolumbar fractures were prospectively assessed by surgeons with different levels of training and experience (attending orthopedic surgeon, attending neurosurgeon, spine fellows, senior level and junior level residents) at a single institution. Plain radiographs, CT and MRI imaging were used to classify these injuries using the TLISS system. Seven months later, 25 consecutive injuries were prospectively assessed with the TLISS and TLICS systems. Unweighted Cohen's kappa coefficients and Spearman's correlation values were calculated to assess inter-observer reliability and validity at each point in time.
For both the TLISS and TLICS algorithms, the inter-rater kappa statistics for all of the subgroups demonstrated moderate-to-substantial reliability (0.45-0.74), although there were no significant differences among the shared subgroups. The kappa score of the TLISS system was greater than that of the TLICS system for injury mechanism/ morphology. Correlation values were also greater across all subgroups (P ≤0.01). Statistically significant improvements in TLISS inter-observer reliability were observed across all TLISS fields (P <0.05). The TLISS and TLICS schemes both demonstrated excellent validity.
The TLISS and TLICS scales both exhibited substantial reliability and validity. However, the TLISS system displayed greater inter-observer correlation than did the TLICS and demonstrated significant improvements in reliability over time.
尽管人们多次尝试对胸腰椎脊柱损伤进行分类，但对于单一统一的管理算法仍未达成共识。理想的系统应提供诊断和预后信息，具有足够的可靠性和有效性，并且易于应用于临床实践。本研究的目的是评估两种新型胸腰椎骨折分类系统——胸腰椎损伤严重程度评分（TLISS）和胸腰椎损伤分类与严重程度评分（TLICS）——的可靠性和有效性，并讨论未来研究的潜在方向。
在一家机构中，由不同培训水平和经验的外科医生（骨科主治医生、神经外科主治医生、脊柱专科住院医师、高年级和低年级住院医师）对71例胸腰椎骨折患者进行前瞻性评估。使用普通X线片、CT和MRI成像，采用TLISS系统对这些损伤进行分类。七个月后，使用TLISS和TLICS系统对连续的25例损伤进行前瞻性评估。计算未加权的科恩kappa系数和斯皮尔曼相关值，以评估每个时间点的观察者间可靠性和有效性。
对于TLISS和TLICS算法，所有亚组的评分者间kappa统计显示出中度至高度的可靠性（0.45 - 0.74），尽管共享亚组之间没有显著差异。在损伤机制/形态方面，TLISS系统的kappa评分高于TLICS系统。所有亚组的相关值也更高（P≤0.01）。在所有TLISS领域，观察者间可靠性在统计学上有显著提高（P <0.05）。TLISS和TLICS方案均显示出优异的有效性。
TLISS和TLICS量表均具有高度的可靠性和有效性。然而，TLISS系统显示出比TLICS更高的观察者间相关性，并且随着时间的推移，可靠性有显著提高。
