Lenke L G, Betz R R, Bridwell K H, Clements D H, Harms J, Lowe T G, Shufflebarger H L
Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri 63110, USA.
J Bone Joint Surg Am. 1998 Aug;80(8):1097-106. doi: 10.2106/00004623-199808000-00002.
The system described by King et al. is the standard method for the classification of thoracic adolescent idiopathic scoliosis. Although it is widely used and referenced, its reliability and reproducibility among scoliosis surgeons are unknown. We used a scoliosis case-presentation format to examine the interobserver and intraobserver reliability of the classification of thoracic adolescent idiopathic scoliosis with the system of King et al. Eight active, current members of the Scoliosis Research Society reviewed twenty-seven full-length radiographs that had been made before operative correction of the scoliotic deformity. On the basis of these images, which included posteroanterior and lateral radiographs made with the patient standing as well as right and left forced-side-bending radiographs made with the patient supine, the reviewers assigned a type to each curve according to the classification system of King et al. Kappa coefficients were used to test statistical reliability. The mean interobserver reliability of the classification was only 64 per cent (range, 54 to 77 per cent) when the responses of seven of the reviewers were compared with those of one of the originators of the classification. The mean kappa coefficient was 0.49 (range, 0.27 to 0.73), which indicates poor reliability. When each reviewer's responses were compared with those of the other reviewers, the reliability was similarly poor (interobserver reliability, 55 per cent [range, 33 to 81 per cent] and mean kappa coefficient, 0.40 [range, 0.21 to 0.63]). Intraobserver reliability was evaluated in a trial in which five reviewers in a group setting were shown the same radiographs in a different order at two different viewings. Comparison of the results at the two viewings revealed a mean intraobserver reliability of 69 per cent (range, 56 to 85 per cent) and a mean kappa coefficient of 0.62 (range, 0.34 to 0.95), which indicates fair reliability. The current method of classification of adolescent idiopathic scoliosis does not appear to have sufficient intraobserver or interobserver reliability among scoliosis surgeons to portray curve types accurately. Thus, it may not help to guide treatment with use of modern spinal fixation methods.
金氏等人所描述的系统是青少年特发性脊柱侧凸胸椎型分类的标准方法。尽管它被广泛使用和引用，但其在脊柱侧凸外科医生中的可靠性和可重复性尚不清楚。我们采用脊柱侧凸病例呈现形式，以金氏等人的系统来检验青少年特发性脊柱侧凸胸椎型分类的观察者间及观察者内可靠性。脊柱侧凸研究学会的八名现任活跃成员查看了二十七张脊柱侧凸畸形手术矫正前拍摄的全长X光片。基于这些影像，包括患者站立位的正位和侧位X光片以及患者仰卧位的左右侧屈X光片，审阅者根据金氏等人的分类系统为每条曲线指定一个类型。kappa系数用于检验统计可靠性。当将七名审阅者的回答与该分类的一位创始人的回答进行比较时，分类的平均观察者间可靠性仅为64%（范围为54%至77%）。平均kappa系数为0.49（范围为0.27至0.73），表明可靠性较差。当将每位审阅者的回答与其他审阅者的回答进行比较时，可靠性同样较差（观察者间可靠性为55%[范围为33%至81%]，平均kappa系数为0.40[范围为0.21至0.63]）。在一项试验中评估了观察者内可靠性，在该试验中，一组中的五名审阅者在两次不同的观看中以不同顺序查看相同的X光片。两次观看结果的比较显示，观察者内平均可靠性为69%（范围为56%至85%），平均kappa系数为0.62（范围为0.34至0.95），表明可靠性尚可。青少年特发性脊柱侧凸的现行分类方法在脊柱侧凸外科医生中似乎没有足够的观察者内或观察者间可靠性来准确描述曲线类型。因此，它可能无助于指导现代脊柱固定方法的治疗。
