胸腰椎骨质疏松性压缩骨折严重程度评分分型系统的可靠性研究
Evaluation of reliability of thoracolumbar osteoporotic vertebral compression fracture severity score system
目的 分析胸腰椎骨质疏松性压缩骨折(OVCF)严重程度评分分型系统(TLOFS)的可重复性信度,为指导胸腰椎OVCF的治疗提供依据. 方法 根据我院制定的TLOFS,回顾性分析2014年1月-2015年6月收治的320例胸腰椎OVCF患者进行评估,其中男107例,女213例;年龄52 ~ 90岁,平均63.7岁.均以腰背痛为主诉就诊.TLOFS≤3分21例和TLOFS=4分17例采用非手术治疗.TLOFS=4分23例和≥5分259例采用手术治疗.以视觉模拟评分(VAS)评分疼痛缓解情况.检验TLOFS的内部一致性信度、可重复性信度及内容效度. 结果 TLOFS亚类(伤椎形态学改变、伤椎MRI表现、骨密度、和临床表现、治疗推荐)及总分评定的一致性信度Cronbach'sα系数位于较高和高度可靠性之间(0.76 ~0.94).TLOFS可重复性信度检验显示,Kappa系数也位于较高和高度可靠性之间(0.84 ~0.95).全部项目的平均内容效度指数为0.916.所有患者取得了良好的效果,VAS由术前的(7.8±2.1)分恢复到末次随访时的(1.3±0.7)分.TLOFS的诊断准确率为95.7%,敏感度为87.6%,特异度为96.5%. 结论 TLOFS具有较高的一致性和可重复性,使用简单,评估较全面和准确,可以有效指导胸腰椎OVCF的治疗.
更多Objective To evaluate the reliability and reproducibility of the thoracolumbar osteoporotic vertebral compression fracture (OVCF) severity score system (TLOFS),so as to provide basis for clinical decision-making.Methods A total of 320 cases of thoracolumbar OVCF hospitalized between January 2014 and June 2015 were scored by TLOFS.There were 107 male and 213 female patients,aged 52-90 years (mean,63.78 years).All cases presented with a chief complaint of low back pain.Thirty-nine cases (TLOFS ≤3 in 21 cases,TLOFS =4 in 17 cases) were treated non-operatively,while 259 cases (TLOFS =4 in 23 cases,TLOFS ≥ 5 in 259 cases) were treated surgically.Pain was evaluated by the visual analogue scale (VAS).Reliability,reproducibility and content validity of the TLOFS were analyzed.Results Cronbach' sα coefficients of all TLOFS subgroups including evaluation of morphological changes,MRI,bone mineral density,clinical situation and therapy recommendation and total score evaluation were within the range of higher to high reliability (0.76-0.94).Kappa coefficients of all TLOFS subgroups were within the range of higher to high reproducibility (0.84-0.95).Mean content validity of all TLOFS subgroups was 0.916.VAS improved from preoperative(7.8 ± 2.1) to (1.3 ±0.7) at the final follow-up.Rates of correct diagnosis,sensitivity and specificity were 95.7%,87.6% and 96.5% respectively.Conclusion TLOFS exhibits good reliability and reproducibility,easy operation,and accurate and comprehensive evaluation,which is effective in guiding the clinical decision making in treatment of thoracolumbar OVCF.
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