Department of Trauma Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Injury. 2012 Apr;43(4):416-22. doi: 10.1016/j.injury.2011.05.013. Epub 2011 Jun 8.
The Load Sharing Classification (LSC) allocates one to three points to each of three different radiological characteristics of traumatic thoracolumbar fractures: the vertebral body involved in the fracture, the displacement of the fracture parts and the kyphotic deformity. Added up, a minimal score of three and a maximal score of nine can be obtained. When the LSC score is three to six, a short segment pedicle screw fixation suffices. When the LSC score is seven to nine, a high rate of failure in patients with a short segment pedicle screw fixation exists. In these cases an anterior stabilising procedure of the spine is advised. The LSC has been examined by Dai and Jin, who claim an almost perfect inter- and intraobserver agreement, according to the Landis and Koch criteria. Dai and Jin only present results for the separate three items of the LSC and for the total LSC scores. Observer agreement for the two LSC score categories (three to six and seven to nine) have not been studied. The aim of this study is to study the inter- and intraobserver agreement of the LSC for the total score, the three separate items and also for the two LSC score categories. Three observers determine twice the LSC scores of forty traumatic thoracolumbar fractures. The average standard Cohen's kappa values for the separate LSC items range between 0.06 and 0.48. For the total LSC score the average standard Cohen's kappa and weighted kappa values are 0.22 and 0.67 respectively. For the two LSC score categories, there is unanimous agreement in 55% of the cases and a majority agreement in 40%. In the remaining 5% of the fractures there is a split decision. Standard Cohen's kappa value for the two LSC score categories is 0.53. The standard Cohen's kappa values can be rated as fair to moderate. From these data it can be concluded that the inter- and intraobserver reliability of the Load Sharing Classification of Spinal fractures can be rated as fair.
负荷分担分类（LSC）将创伤性胸腰椎骨折的三个不同放射学特征中的每一个分配一到三分：骨折涉及的椎体、骨折部位的移位和后凸畸形。最小得分为 3 分，最大得分为 9 分。当 LSC 评分为 3 至 6 分时，短节段椎弓根螺钉固定就足够了。当 LSC 评分为 7 至 9 分时，短节段椎弓根螺钉固定的患者失败率很高。在这些情况下，建议采用脊柱前路稳定术。Dai 和 Jin 已经对 LSC 进行了检查，根据 Landis 和 Koch 标准，他们声称具有近乎完美的观察者间和观察者内一致性。Dai 和 Jin 仅展示了 LSC 三个单独项目和总 LSC 评分的结果。尚未研究观察者对 LSC 两个评分类别的一致性（3 至 6 和 7 至 9）。本研究旨在研究 LSC 总分、三个单独项目以及两个 LSC 评分类别的观察者间和观察者内一致性。三位观察者两次确定 40 例创伤性胸腰椎骨折的 LSC 评分。单独 LSC 项目的平均标准 Cohen's kappa 值在 0.06 至 0.48 之间。对于总 LSC 评分，平均标准 Cohen's kappa 和加权 kappa 值分别为 0.22 和 0.67。对于两个 LSC 评分类别，在 55%的病例中存在一致意见，在 40%的病例中存在多数意见。在其余 5%的骨折中存在分歧决定。两个 LSC 评分类别的标准 Cohen's kappa 值为 0.53。标准 Cohen's kappa 值可评为公平至中度。从这些数据可以得出结论，脊柱骨折负荷分担分类的观察者间和观察者内可靠性可评为公平。
