AO 脊柱上颈椎损伤分类的全球验证。
Global Validation of the AO Spine Upper Cervical Injury Classification.
机构信息
Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
Department of Orthopedic Surgery, University Medical Center, University of Utrecht, Utrecht, the Netherlands.
出版信息
Spine (Phila Pa 1976). 2022 Nov 15;47(22):1541-1548. doi: 10.1097/BRS.0000000000004429. Epub 2022 Jul 25.
STUDY DESIGN
Global cross-sectional survey.
OBJECTIVE
To determine the classification accuracy, interobserver reliability, and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on an international group of AO Spine members.
SUMMARY OF BACKGROUND DATA
Previous upper cervical spine injury classifications have primarily been descriptive without incorporating a hierarchical injury progression within the classification system. Further, upper cervical spine injury classifications have focused on distinct anatomical segments within the upper cervical spine. The AO Spine Upper Cervical Injury Classification System incorporates all injuries of the upper cervical spine into a single classification system focused on a hierarchical progression from isolated bony injuries (type A) to fracture dislocations (type C).
METHODS
A total of 275 AO Spine members participated in a validation aimed at classifying 25 upper cervical spine injuries through computed tomography scans according to the AO Spine Upper Cervical Classification System. The validation occurred on two separate occasions, three weeks apart. Descriptive statistics for percent agreement with the gold-standard were calculated and the Pearson χ 2 test evaluated significance between validation groups. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility.
RESULTS
The accuracy of AO Spine members to appropriately classify upper cervical spine injuries was 79.7% on assessment 1 (AS1) and 78.7% on assessment 2 (AS2). The overall intraobserver reproducibility was substantial (κ=0.70), while the overall interobserver reliability for AS1 and AS2 was substantial (κ=0.63 and κ=0.61, respectively). Injury location had higher interobserver reliability (AS1: κ = 0.85 and AS2: κ=0.83) than the injury type (AS1: κ=0.59 and AS2: 0.57) on both assessments.
CONCLUSION
The global validation of the AO Spine Upper Cervical Injury Classification System demonstrated substantial interobserver agreement and intraobserver reproducibility. These results support the universal applicability of the AO Spine Upper Cervical Injury Classification System.
LEVEL OF EVIDENCE
研究设计
全球横断面调查。
目的
基于国际 AO 脊柱会员小组，确定 AO 脊柱上颈椎损伤分类系统的分类准确性、观察者间可靠性和观察者内可重复性。
背景资料总结
以前的上颈椎损伤分类主要是描述性的，没有在分类系统中纳入分级损伤进展。此外，上颈椎损伤分类主要集中在上颈椎的不同解剖部位。AO 脊柱上颈椎损伤分类系统将上颈椎的所有损伤纳入一个单一的分类系统，侧重于从孤立性骨损伤（A型）到骨折脱位（C 型）的分级进展。
方法
共有 275 名 AO 脊柱会员参与了一项验证，旨在通过 CT 扫描对 25 例上颈椎损伤进行分类，根据 AO 脊柱上颈椎分类系统进行分类。验证分两次进行，相隔三周。计算与金标准的百分比一致性的描述性统计数据，并通过 Pearson χ 2 检验评估验证组之间的显著性。kappa 系数（κ）确定了观察者间的可靠性和观察者内的可重复性。
结果
AO 脊柱会员正确分类上颈椎损伤的准确率在第一次评估（AS1）为 79.7%，在第二次评估（AS2）为 78.7%。整体观察者内可重复性较高（κ=0.70），而 AS1 和 AS2 的整体观察者间可靠性也较高（κ=0.63 和 κ=0.61）。在两次评估中，损伤部位的观察者间可靠性均较高（AS1：κ=0.85 和 AS2：κ=0.83），而损伤类型的观察者间可靠性较低（AS1：κ=0.59 和 AS2：0.57）。
结论
AO 脊柱上颈椎损伤分类系统的全球验证表明观察者间一致性和观察者内可重复性较高。这些结果支持 AO 脊柱上颈椎损伤分类系统的普遍适用性。
证据等级
4 级。
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