The Load-Sharing Classification Method In The Thoracolumbar Fractures Application Of Intraobserver Reliability And Interobserver Reproducibility

Objective:To determine the reliability and reproducibility of Thoracolumbar Injury using Load-Sharing Classification and analyze the reason for the disagreement providing theories for clinical application.Methods:A total of45cases of thoracolumbar spinal trauma were distributed to6attending spine surgeons, including two surgeons of each level. Use Load-sharing Classification to grade the45patients, with the help of X-rays, CT and MRI data, select appropriate formula according to the result of the grading. Three months later, the radiographic data were scored once more after disordering the former data and the results were examined by applying to Kappa standards, calculating the Kappa value. Comparing the results of grading by six surgeons with each other, we can get the Kappa value applying to the research of the reliability; Comparing the former results with the latter ones of each surgeon respectively, we can get the Kappa value applying to the research of the reproducibility. Additionally, determine the reliability and reproducibility of the Load-sharing Classification using the standards of Landis and Koch and the formula x±s. Results:Interobserver Reliability in the Load-Sharing Classification:When the results were analyzed using Load-Sharing classification, during the first assessment for grading thoracolumbar spinal fracture, the Kappa values ranged from0.66to0.97, Kappa value equaled(0.76±0.09); about displacement of fracture fragments, the Kappa values ranged from0.77to0.97, the Kappa value equaled(0.88±0.05);about the deformity correction, the Kappa values ranged from0.70to0.91, the Kappa value equaled(0.77±0.06). The general Kappa values ranged from0.76to0.88, the general Kappa values equaled (0.82±0.04). During the second assessment for grading thoracolumbar spinal fracture, the Kappa values ranged from0.62to0.96, Kappa value equaled(0.78±0.11); about displacement of fracture fragments, the Kappa values ranged from0.80to0.97, the Kappa value equaled(0.87±0.04);about the deformity correction, the Kappa values ranged from0.65to0.84, the Kappa value equaled (0.82±0.04). The general Kappa values ranged from0.76to0.88, the general Kappa values equaled (0.82±0.04).Intraobserver Reproducibility in the Load-Sharing Classification:Of the grading thoracolumbar spinal fracture, the Kappa values ranged from0.80to0.93, the Kappa value equaled (0.89±0.05); About displacement of fracture fragments, the Kappa values ranged from0.83to0.93, the Kappa value equaled (0,89±0.04);About the deformity correction, the Kappa values ranged from0.86to0.91, the Kappa value equaled (0.88±0.02).The general Kappa values ranged from0.85to0.92, the Kappa value equaled(0.89±0.03).The reliability of the formula in the Load-sharing Classification:during the first assessment for15sets of data, the Kappa values ranged from0.91to1.00, the Kappa value equaled (0.96±0.03); during the second assessment for the same15sets of data, the Kappa values ranged from0.87to1.00, the Kappa value equaled (0.93±0.04).The reproducibility of the formula in the Load-sharing Classification:the Kappa values ranged from0.91to1.00, the Kappa value equaled (0.97±0.03). According to Landis and Koch Standards, the reliability of the three elements of Load-Sharing classification shows:the degree of thoracolumbar fractures and the deformity correction were at a better level. The Kappa values of displacement of fracture fragments was at the almost perfect level. The general reliability reached the almost perfect level.The reproducibility of the three elements of Load-sharing Classification shows:the degree of thoracolumbar fractures, displacement of fracture fragments and the deformity correction were all at a perfect level. The formula of Load-sharing Classification:the reliability and reproducibility were both at a perfect level.Conclusions:the reliability and the reproducibility of the Load-sharing classification are at the almost perfect level. The formula of Load-sharing Classification were at the almost perfect level of reliability and reproducibility as well.