The Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, #1519 Dongyue Avenue, Nanchang, 330209, Jiangxi, China.
Department of Orthopedics, General Hospital of Ningxia Medical University, Ningxia, China.
Arch Orthop Trauma Surg. 2023 Sep;143(9):5565-5574. doi: 10.1007/s00402-023-04869-z. Epub 2023 Apr 8.
Osteotomized debridement (OD) is increasingly used in the treatment of active thoracolumbar tuberculosis (TB). So far, no nomenclature has been established to describe the patterns of OD, and thus the surgical outcomes cannot be directly analyzed and compared among the patients treated with different extents of OD. The purpose of this study was to establish a reliable classification of OD for further study of spinal TB.
This was a multicenter retrospective study. The proposed classification included 6 grades of OD based on sagittal range of vertebral body destruction: grade 0 involves single-level intervertebral disc and adjacent superficial endplates; grade 1 involves adjacent endplates and vertebral bodies, but no pedicle is involved; grade 2 involves adjacent endplates, vertebral bodies, and a lower or upper pedicle; grade 3 involves adjacent endplates, vertebral bodies, and both of lower and upper pedicles; grade 4 involves an entire vertebral body and an adjacent lower or upper pedicle; grade 5 involves two continuous entire vertebral bodies. Two hundred and five patients with active thoracolumbar TB who underwent OD surgery were included, and all ODs were classified. The reliability of this classification was evaluated twice by 10 readers, and Fleiss kappa coefficients were calculated.
In the 205 patients, 208 ODs were performed. Grade 2 OD was the commonest type (98/208, 47.1%), followed by grade 1 (50/208, 24.0%), grade 3 (26/208, 12.5%), grade 0 (20/208, 9.6%), grade 4 (8/208, 3.8%), and grade 5 (6/208, 2.9%). The average accuracy of the two readings was 86.2% and 90.1%, respectively. The intra-rater reliability for the classification was "almost perfect agreement" with a Fleiss kappa coefficient average of 0.92. The inter-rater reliability was "almost perfect agreement" with a coefficient average of 0.89 for two readings.
This classification proved to be intuitive and reliable. The graded OD provides a platform for preoperative evaluation and allows comparative analysis of clinical outcomes in different extents of OD.
截骨清创术（OD）在治疗活动性胸腰椎结核（TB）中越来越多地被应用。到目前为止，还没有建立描述 OD 模式的命名法，因此不能直接分析和比较不同程度 OD 治疗的患者的手术结果。本研究的目的是建立一种可靠的 OD 分类，以便进一步研究脊柱结核。
这是一项多中心回顾性研究。提出的分类包括基于矢状面椎体破坏范围的 6 级 OD：0 级涉及单节段椎间盘和相邻的浅层终板；1 级涉及相邻终板和椎体，但不涉及椎弓根；2 级涉及相邻终板、椎体和下或上椎弓根；3 级涉及相邻终板、椎体和下、上椎弓根；4 级涉及整个椎体和相邻的下或上椎弓根；5 级涉及两个连续的整个椎体。共纳入 205 例活动性胸腰椎结核患者行 OD 手术，对所有 OD 进行分类。由 10 位读者对该分类进行了两次评估，计算了 Fleiss kappa 系数，以评估其可靠性。
在 205 例患者中，共进行了 208 次 OD。2 级 OD 最常见（98/208，47.1%），其次是 1 级（50/208，24.0%）、3 级（26/208，12.5%）、0 级（20/208，9.6%）、4 级（8/208，3.8%）和 5 级（6/208，2.9%）。两次阅读的平均准确率分别为 86.2%和 90.1%。分类的内部评估者可靠性为“极好的一致性”，Fleiss kappa 系数平均为 0.92。两次阅读的组间评估者可靠性为“极好的一致性”，系数平均为 0.89。
该分类直观可靠。分级 OD 为术前评估提供了平台，并允许对不同程度 OD 的临床结果进行比较分析。
