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目的 :分析Tomita评分结合脊柱肿瘤不稳评分(spinal instability neoplastic score,SINS)和改良Tokuhashi评分结合SINS评分用于脊柱转移瘤患者治疗决策的可信度和可重复性,评价两套评分系统临床运用价值。方法:3名具有一定临床经验的脊柱外科医生对41例脊柱转移瘤患者进行回顾性分析。这3名脊柱外科医生用Tomita评分、改良Tokuhashi评分、SINS评分对每位患者进行评分,并运用改良Tokuhashi结合SINS评分及Tomita结合SINS评分决定患者的治疗方案。间隔20天后对上述病例进行重复分析,分析观察者间一致性和观察者内一致性。结果:Tomita结合SINS评分用于治疗决策时,平均观察者间一致性Kappa值为0.78(0.75~0.81),平均观察者内一致性Cronbach′sα系数为0.79(0.77~0.82)。改良Tokuhashi结合SINS评分用于治疗决策时,平均观察者间一致性Kappa值为0.68(0.65~0.72),平均观察者内一致性Cronbach′sα系数为0.73(0.72~0.75)。有17.9%的患者在两组系统评估后而得出不同治疗方案。结论:Tomita结合SINS评分和改良Tokuhashi结合SINS评分均具有较好的可信度和可重复性。
OBJECTIVE: To analyze the reliability and repeatability of the Tomita score combined with the spinal instability neoplastic score (SINS) and the modified Tokuhashi score with the SINS score for the treatment decision of patients with spinal metastases and evaluate the clinical application of two scoring systems value. METHODS: Three spine surgeons with some clinical experience were retrospectively analyzed in 41 patients with spinal metastases. The three spinal surgeons rated each patient using the Tomita score, the modified Tokuhashi score, the SINS score, and the modified Tokuhashi combined with the SINS score and Tomita with the SINS score to determine the patient’s treatment regimen. After 20 days, the above cases were analyzed repeatedly to analyze the interobserver agreement and intraobserver agreement. Results: The mean interobserver agreement (Kappa) was 0.78 (0.75-0.81) and the mean intraobserver agreement Cronbach’s alpha was 0.79 (0.77-0.82) when Tomita was used in treatment decisions. When the modified Tokuhashi combined with SINS score was used for treatment decision, the average interobserver consistency Kappa value was 0.68 (0.65-0.72) and the average intraobserver consistency Cronbach’s alpha coefficient was 0.73 (0.72-0.75). In 17.9% of patients, different treatment regimens were obtained after two systematic reviews. Conclusion: Tomita combined with SINS score and modified Tokuhashi combined with SINS score have good reliability and repeatability.