Pishnamaz Miguel, Balosu Stephan, Curfs Inez, Uhing Daniel, Laubach Markus, Herren Christian, Weber Christian, Hildebrand Frank, Willems Paul, Kobbe Philipp
Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany.
Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany.
World Neurosurg. 2018 Jul;115:e695-e702. doi: 10.1016/j.wneu.2018.04.138. Epub 2018 Apr 27.
Currently, no spinal classification system has achieved universal acceptance. Therefore, it is important to choose a reliable classification within clinical practice. The objective of this study was to determine and compare the intraobserver and interobserver agreement of the Load Sharing Classification (LSC), the Thoracolumbar Injury Classification System (TLICS), and the AOSpine Thoracolumbar Spine Injury Classification System.
In this web-based intraobserver and interobserver study (www.spine.hostei.com), plain radiographs and computed tomographic scans of traumatic thoracolumbar fractures (T12-L2) were evaluated. By use of a questionnaire, fractures were classified according to the LSC, the TLICS, and the AOSpine classification. Data were analyzed with SPSS (Version 21, 76 Chicago, Illinois, USA). Intraobserver and interobserver agreement was determined by the Cohen κ. Statistical significance was defined as P < 0.05.
Data from 91 patients were classified twice by 7 board-certified spine surgeons. The intraobserver and interobserver reliability considering the LSC total score was noted as fair (intraobserver/interobserver reliability: κ = 0.26/0.22). Considering the resulting TLICS total score, a moderate intraobserver agreement (κ = 0.41) was noted, whereas the interobserver results presented only fair reliability (κ = 0.23). In contrast to the LSC and the TLICS, the AOSpine classification showed substantial agreement considering the fracture type (A;B;C) (intraobserver/interobserver reliability: κ = 0.71/0.61) and moderate agreement considering the fracture subtype (e.g., A0;A1;…;B1;…) (intraobserver/interobserver reliability: κ = 0.57/0.48).
In conclusion, the reliability of the AOSpine fracture classification is superior to the TLICS and the LSC. Therefore, this classification system could best be applied within clinical practice.
目前，尚无脊柱分类系统获得普遍认可。因此，在临床实践中选择可靠的分类方法很重要。本研究的目的是确定并比较载荷分担分类法（LSC）、胸腰椎损伤分类系统（TLICS）和AO脊柱胸腰椎损伤分类系统在观察者内和观察者间的一致性。
在这项基于网络的观察者内和观察者间研究（www.spine.hostei.com）中，对创伤性胸腰椎骨折（T12-L2）的X线平片和计算机断层扫描进行评估。通过问卷调查，根据LSC、TLICS和AO脊柱分类法对骨折进行分类。使用SPSS（版本21，美国伊利诺伊州芝加哥）分析数据。观察者内和观察者间的一致性通过Cohen κ系数确定。统计学显著性定义为P < 0.05。
91例患者的数据由7名获得委员会认证的脊柱外科医生进行了两次分类。考虑LSC总分时，观察者内和观察者间的可靠性为中等（观察者内/观察者间可靠性：κ = 0.26/0.22）。考虑TLICS总分时，观察者内一致性为中等（κ = 0.41），而观察者间结果仅显示中等可靠性（κ = 0.23）。与LSC和TLICS不同，AO脊柱分类法在骨折类型（A；B；C）方面显示出高度一致性（观察者内/观察者间可靠性：κ = 0.71/0.61），在骨折亚型（例如，A0；A1；…；B1；…）方面显示出中等一致性（观察者内/观察者间可靠性：κ = 0.57/0.48）。
总之，AO脊柱骨折分类法的可靠性优于TLICS和LSC。因此，该分类系统最适合应用于临床实践。
