Lu Wen-Jie, Zhang Jiaming, Deng Yuan-Guo, Jiang Wei-Yu
Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China.
The Second Clinical Medical School of Zhejiang Chinese Medicine University, Hangzhou, China.
Front Surg. 2023 Jan 6;9:1054031. doi: 10.3389/fsurg.2022.1054031. eCollection 2022.
On the basis of the Thoracolumbar Injury Classification and Severity Score (TLICS), an modified TLICS classification system was presented, its reliability and repeatability were assessed, and the factors influencing classification consistency were examined.
Five spinal surgeons were chosen at random. The clinical data of 120 patients with thoracolumbar fractures admitted to the Department of Spine Surgery, Ningbo Sixth Hospital from December 2019 to June 2021 were categorized using the modified TLICS system. After 6 weeks, disrupt the order of data again. Using unweighted Cohen's kappa coefficients, the consistency of the modified TLICS system was assessed in five aspects: neurofunctional status, disc injury status, fracture morphology, posterior ligament complex (PLC) integrity, and treatment plan.
In terms of reliability, the average kappa values for the subclasses of the modified TLICS system (neurofunctional status and disc injury status) were 0.920 and 0.815, respectively, reaching the category of complete confidence. Fracture morphology and treatment plan had average kappa values of 0.670 and 0.660, respectively, which were basically reliable. The average kappa value of PLC integrity was 0.453, which belonged to the category of moderate confidence. The average kappa coefficients of each subcategory (neurological status, disc injury status) had excellent consistency, and the kappa values were 0.936 and 0.879, respectively, which belonged to the completely credible category. The kappa values of fracture morphology and treatment plan repeatability were 0.772 and 0.749, respectively, reaching the basic credibility category. PLC integrity repeatability kappa value is low, 0.561, to moderate credibility category.
The modified TLICS system is intuitive and straightforward to understand. The examination of thoracolumbar fracture injuries is more exhaustive and precise, with excellent reliability and repeatability. The examination of neurological status and disc injury status is quite reliable and consistent. The consistency of fracture morphology is slightly poor, which is basically credible; the PLC integrity consistency is poor, reaching a reliability level of moderate, which may be associated with the subjectivity of clinical evaluation of PLC.
基于胸腰椎损伤分类及严重程度评分（TLICS），提出一种改良的TLICS分类系统，评估其可靠性和重复性，并探讨影响分类一致性的因素。
随机选取5名脊柱外科医生。采用改良的TLICS系统对2019年12月至2021年6月在宁波市第六医院脊柱外科住院的120例胸腰椎骨折患者的临床资料进行分类。6周后，再次打乱数据顺序。使用非加权Cohen's kappa系数，从神经功能状态、椎间盘损伤状态、骨折形态、后韧带复合体（PLC）完整性和治疗方案五个方面评估改良TLICS系统的一致性。
在可靠性方面，改良TLICS系统各亚类（神经功能状态和椎间盘损伤状态）的平均kappa值分别为0.920和0.815，达到完全可信类别。骨折形态和治疗方案的平均kappa值分别为0.670和0.660，基本可靠。PLC完整性的平均kappa值为0.453，属于中度可信类别。各亚类（神经学状态、椎间盘损伤状态）的平均kappa系数具有极好的一致性，kappa值分别为0.936和0.879，属于完全可信类别。骨折形态和治疗方案重复性的kappa值分别为0.772和0.749，达到基本可信类别。PLC完整性重复性kappa值较低，为0.561，属于中度可信类别。
改良的TLICS系统直观易懂。对胸腰椎骨折损伤的检查更详尽、精确，具有良好的可靠性和重复性。神经学状态和椎间盘损伤状态的检查相当可靠且一致。骨折形态的一致性稍差，基本可信；PLC完整性一致性差，可靠性为中度，这可能与PLC临床评估的主观性有关。
