Kaul Rahul, Chhabra Harvinder Singh, Vaccaro Alexander R, Abel Rainer, Tuli Sagun, Shetty Ajoy Prasad, Das Kali Dutta, Mohapatra Bibhudendu, Nanda Ankur, Sangondimath Gururaj M, Bansal Murari Lal, Patel Nishit
Department of Orthopedics, Flt. Lt. Rajan Dhal, Fortis Hospital, Vasant Kunj, New Delhi, India.
Indian Spinal Injuries Center, Sector C, Vasant Kunj, New Delhi, India.
Eur Spine J. 2017 May;26(5):1470-1476. doi: 10.1007/s00586-016-4663-5. Epub 2016 Jun 22.
The aim of this multicentre study was to determine whether the recently introduced AOSpine Classification and Injury Severity System has better interrater and intrarater reliability than the already existing Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries.
Clinical and radiological data of 50 consecutive patients admitted at a single centre with a diagnosis of an acute traumatic thoracolumbar spine injury were distributed to eleven attending spine surgeons from six different institutions in the form of PowerPoint presentation, who classified them according to both classifications. After time span of 6 weeks, cases were randomly rearranged and sent again to same surgeons for re-classification. Interobserver and intraobserver reliability for each component of TLICS and new AOSpine classification were evaluated using Fleiss Kappa coefficient (k value) and Spearman rank order correlation.
Moderate interrater and intrarater reliability was seen for grading fracture type and integrity of posterior ligamentous complex (Fracture type: k = 0.43 ± 0.01 and 0.59 ± 0.16, respectively, PLC: k = 0.47 ± 0.01 and 0.55 ± 0.15, respectively), and fair to moderate reliability (k = 0.29 ± 0.01 interobserver and 0.44+/0.10 intraobserver, respectively) for total score according to TLICS. Moderate interrater (k = 0.59 ± 0.01) and substantial intrarater reliability (k = 0.68 ± 0.13) was seen for grading fracture type regardless of subtype according to AOSpine classification. Near perfect interrater and intrarater agreement was seen concerning neurological status for both the classification systems.
Recently proposed AOSpine classification has better reliability for identifying fracture morphology than the existing TLICS. Additional studies are clearly necessary concerning the application of these classification systems across multiple physicians at different level of training and trauma centers to evaluate not only their reliability and reproducibility, but also the other attributes, especially the clinical significance of a good classification system.
这项多中心研究的目的是确定最近推出的AO脊柱损伤分类及严重程度系统与现有的胸腰椎损伤分类及严重程度评分（TLICS）相比，在评估胸腰椎脊柱损伤时，其评分者间和评分者内的可靠性是否更高。
以PowerPoint演示文稿的形式，将一家中心连续收治的50例诊断为急性创伤性胸腰椎脊柱损伤患者的临床和放射学资料分发给来自六个不同机构的11位脊柱外科主治医生，让他们根据这两种分类方法对病例进行分类。6周后，病例被随机重新排列，并再次发送给相同的医生进行重新分类。使用Fleiss Kappa系数（k值）和Spearman等级相关法评估TLICS和新的AO脊柱损伤分类各组成部分的观察者间和观察者内可靠性。
在骨折类型分级和后韧带复合体完整性方面，观察到中度的评分者间和评分者内可靠性（骨折类型：k值分别为0.43±0.01和0.59±0.16；PLC：k值分别为0.47±0.01和0.55±0.15），根据TLICS得出的总分的可靠性为中等偏下（观察者间k值为0.29±0.01，观察者内k值为0.44±0.10）。根据AO脊柱损伤分类，无论骨折亚型如何，在骨折类型分级方面观察到中度的评分者间可靠性（k值为0.59±0.01）和较高的评分者内可靠性（k值为0.68±0.13）。对于这两种分类系统，在神经功能状态方面观察到近乎完美的评分者间和评分者内一致性。
最近提出的AO脊柱损伤分类在识别骨折形态方面比现有的TLICS具有更高的可靠性。显然有必要进行更多研究，以评估这些分类系统在不同培训水平的多名医生以及不同创伤中心的应用情况，不仅要评估其可靠性和可重复性，还要评估其他属性，特别是一个良好分类系统的临床意义。
