Lambrechts Mark J, Schroeder Gregory D, Karamian Brian A, Canseco Jose A, Bransford Richard, Oner Cumhur, Benneker Lorin M, Kandziora Frank, Shanmuganathan Rajasekaran, Kanna Rishi, Joaquim Andrei F, Chapman Jens R, Vialle Emiliano, El-Sharkawi Mohammad, Dvorak Marcel, Schnake Klaus, Kepler Christopher K, Vaccaro Alexander R
Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Department of Orthopaedicand Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
Global Spine J. 2024 Apr;14(3):821-829. doi: 10.1177/21925682221124100. Epub 2022 Aug 29.
Global Survey.
To determine the accuracy, interobserver reliability, and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeons' AO Spine region of practice (Africa, Asia, Central/South America, Europe, Middle East, and North America).
A total of 275 AO Spine members assessed 25 upper cervical spine injuries and classified them according to the AO Spine Upper Cervical Injury Classification System. Reliability, reproducibility, and accuracy scores were obtained over two assessments administered at three-week intervals. Kappa coefficients (ƙ) determined the interobserver reliability and intraobserver reproducibility.
On both assessments, participants from Europe and North America had the highest classification accuracy, while participants from Africa and Central/South America had the lowest accuracy ( < .0001). Participants from Africa (assessment 1 (AS1):ƙ = .487; AS2:0.491), Central/South America (AS1:ƙ = .513; AS2:0.511), and the Middle East (AS1:0.591; AS2: .599) achieved moderate reliability, while participants from North America (AS1:ƙ = .673; AS2:0.648) and Europe (AS1:ƙ = .682; AS2:0.681) achieved substantial reliability. Asian participants obtained substantial reliability on AS1 (ƙ = .632), but moderate reliability on AS2 (ƙ = .566). Although there was a large effect size, the low number of participants in certain regions did not provide adequate certainty that AO regions affected the likelihood of participants having excellent reproducibility ( = .342).
The AO Spine Upper Cervical Injury Classification System can be applied with high accuracy, interobserver reliability, and intraobserver reproducibility. However, lower classification accuracy and reliability were found in regions of Africa and Central/South America, especially for severe atlas injuries (IIB and IIC) and atypical hangman's type fractures (IIIB injuries).
全球调查。
基于外科医生所在的AO脊柱区域（非洲、亚洲、中/南美洲、欧洲、中东和北美洲），确定AO脊柱上颈椎损伤分类系统的准确性、观察者间可靠性和观察者内可重复性。
共有275名AO脊柱成员评估了25例上颈椎损伤，并根据AO脊柱上颈椎损伤分类系统对其进行分类。在间隔三周进行的两次评估中获得可靠性、可重复性和准确性评分。kappa系数（ƙ）确定观察者间可靠性和观察者内可重复性。
在两次评估中，来自欧洲和北美洲的参与者分类准确性最高，而来自非洲和中/南美洲的参与者准确性最低（P<0.0001）。来自非洲（评估1（AS1）：ƙ = 0.487；AS2：0.491）、中/南美洲（AS1：ƙ = 0.513；AS2：0.511）和中东（AS1：0.591；AS2：0.599）的参与者达到了中等可靠性，而来自北美洲（AS1：ƙ = 0.673；AS2：0.648）和欧洲（AS1：ƙ = 0.682；AS2：0.681）的参与者达到了较高可靠性。亚洲参与者在AS1上获得了较高可靠性（ƙ = 0.632），但在AS2上获得了中等可靠性（ƙ = 0.566）。尽管效应量较大，但某些地区的参与者数量较少，无法充分确定AO区域是否会影响参与者具有出色可重复性的可能性（P = 0.342）。
AO脊柱上颈椎损伤分类系统可以在高准确性、观察者间可靠性和观察者内可重复性的情况下应用。然而，在非洲和中/南美洲地区发现分类准确性和可靠性较低，尤其是对于严重的寰椎损伤（IIB和IIC）和非典型绞刑者型骨折（IIIB损伤）。
