背景:上颈椎复合体骨折与较高的神经损伤率和死亡率相关。Dickman分类在上颈椎复杂骨折的诊断中有着广泛的应用。然而,它不足以覆盖复杂骨折的全部范围。这种限制阻碍了对这些损伤的有效诊断和治疗。
目的:为了解决上颈椎复杂骨折的诊断差距,这项研究为这些损伤引入了一种新的分类系统,评估其可靠性和可用性。
方法:上颈椎复杂骨折新分类系统的建议。
方法:本研究包括242例上颈椎复杂骨折患者的临床资料,包括在我们医院接受治疗的32名患者,以及文献中的另外210例。
方法:观察者间和观察者内可靠性(kappa系数,该分类系统的κ)由3名脊柱外科医生进行了研究。3名研究人员在3个月后独立重新评估了上颈椎复杂骨折分类系统。
方法:建议的分类将上颈椎复杂骨折分为三种主要类型:I型将齿状突和Hangman骨折分为两种亚型;II型将C1与齿状突/Hangman骨折合并为三种亚型;III型包括C1,齿状突,和Hangman的骨折,分为两个亚型。同时,对15名评估者进行了问卷调查,以评估该系统的易用性和临床适用性。
结果:使用我们的系统,共有45例(18.6%)无法通过Dickman分类进行分类。观察者间可靠性的平均κ值为0.783,表明可靠性很高。观察者内部可靠性的平均κ值为0.862,表明几乎完美的可靠性。同时,13名评估员(87.7%)表示分类系统很容易记住,易于应用,他们表示打算在未来的临床实践中应用它。
结论:该系统不仅具有很高的可信度和可重复性,而且可以作为临床医生制定治疗计划的精确指南。未来的前瞻性应用有必要进一步评估此分类系统。
BACKGROUND: Upper cervical complex fractures are associated with high rates of neurological damage and mortality. The Dickman\'s classification is widely used in the diagnosis of upper cervical complex fractures. However, it falls short of covering the full spectrum of complex fractures. This limitation hinders effective diagnosis and treatment of these injuries.
OBJECTIVE: To address the diagnostic gap in upper cervical complex fractures, the study introduces a novel classification system for these injuries, assessing its reliability and usability.
METHODS: Proposal of a new classification system for upper cervical complex fractures.
METHODS: The study comprised the clinical data of 242 patients with upper cervical complex fractures, including 32 patients treated at our hospital, along with an additional 210 cases from the literature.
METHODS: The inter-observer and intra-observer reliability (kappa coefficient, κ) of this classification system were investigated by 3 spine surgeons. The three researchers independently re-evaluated the upper cervical complex fracture classification system 3 months later.
METHODS: The proposed classification categorizes upper cervical complex fractures into three main types: Type I combines odontoid and Hangman\'s fractures into two subtypes; Type II merges C1 with odontoid/Hangman\'s fractures into three subtypes; and Type III encompasses a combination of C1, odontoid, and Hangman\'s fractures, divided into two subtypes. Meanwhile, a questionnaire was administered in 15 assessors to evaluate the system\'s ease of use and clinical applicability.
RESULTS: A total of 45 cases (18.6%) unclassifiable by Dickman\'s classification were successfully categorized using our system. The mean κ value of inter-observer reliability was 0.783, indicating substantial reliability. The mean κ value of intra-observer reliability was 0.862, indicating almost perfect reliability. Meanwhile, thirteen assessors (87.7%) stated that the classification system is easy to remember, easy to apply, and they expressed intentions to apply it in clinical practice in the future.
CONCLUSIONS: This system not only offers high confidence and reproducibility but also serves as a precise guide for clinicians in formulating treatment plans. Future prospective applications are warranted to further evaluate this classification system.