脊柱侧凸Lenke分型和PUMC分型系统一致性差异对手融合范围影响的比较研究

摘要

目的 比较脊柱侧凸Lenke分型和协和(PUMC)分型系统一致性差异对手术融合范围的影响.方法 随机选取青少年特发性脊柱侧凸62例,5名脊柱外科医生根据术前站立正侧位、仰卧位左右弯曲X线片进行分型.3周后,将病例顺序打乱,重复相同程序分型,每个病例共计10人次分型.根据5名医生的分型结果,分别探讨两种分型产生的一致性差异对手术融合范围选择的影响.结果 Lenke分型系统弯曲类型参数及PUMC分型的一致性均很好.Lenke分型弯曲类型参数10人次分型结果24例有分歧,PUMC分型10人次分型结果17例有分歧,差异无统计学意义.Lenke弯曲类型分歧病例中仅2例不影响融合范围,PUMC分歧病例中有7例不影响融合范围,差异有统计学意义.24例Lenke弯曲类型分歧病例用PUMC分型,有14例一致;17例PUMC分歧病例用Lenke弯曲类型分型,7例一致,但做一致性检验表明两种分型一致性好.24例Lenke弯曲类型分歧病例用PUMC分型后有19例不影响融合范围,17例PUMC分歧病例用Lenke弯曲类型分型后只有9例不影响融合范围,差异无统计学意义.结论 Lenke分型中决定手术融合范围的是弯曲类型参数,其与PUMC分型的可信度和可重复性均很好.但PUMC分型较简单实用,较少引起分歧,即使引起分歧,也有近半数的病例并不影响手术融合范围的选择.%Objective To compare the effect of reliability between Lenke and Peking Union Medi-cal College (PUMC) classification systems for Adolescent Idiopathic Scoliosis (AIS) upon surgical fusion range. Methods 62 scoliosis cases were classificated according to Lenke classification system and PUMC classification system by 5 spine surgeons, and each case was done twice. The reliability and consistency be-tween the two classification systems were investigated and evaluated. Results The reliability and consis-tency were good-to-excellent in the curve type parameter of Lenke classification system and PUMC classifi-cation system. According to Lenke curve type classification, there were 24 cases of disagreements, 2 cases of them without effection to bone fusion. According PUMC classification, there were 17 cases of disagreements, 7 of them without effection to fnsio. In the 24 Lenke disagreemrnt cases, 14 cases had the consistency result according to PUMC classification; while in 17 PUMC disagreement cases, 7 cases had the consistency result according to Lenke curve type classification. There were good coherence between the two classification sys-tems. 24 Lenke disagreement cases categorized according to PUMC classification, 19 cases did not affect fu-sion range; while 17 PUMC disagreements cases placed under Lenke curve type classification only 9 cases did not affect fusion level. There were no significant difference. Conclusion In Lenke classification system curve type parameter determines fusion levels, sharing good-to-excellent reliability to the PUMC classifica-tion. However the PUMC classification is simpler in use, with fewer disagreements, as well as nearly half of disagreement cases not affecting fusion levels selection.