前屈试验、脊柱测量仪与Cobb角的比较

An assessment of screening value of forward bending test and scoliometer

目的评价脊柱测量仪（scoliometer）和前屈试验在青少年脊柱畸形筛查中的价值。方法对56例怀疑有脊柱畸形的青少年，男14例，女42例，平均年龄13岁（SD=1．76），用前屈试验、脊柱测量和全脊柱X线片检查。对这三种检查方法的结果划分等级，当Cobb角〈10°为阴性，10°～20°为阳性，〉20°为明显阳性。当前屈试验时背部没有不对称，则为阴性；有不对称，则为阳性；显著不对称为明显阳性。当脊柱测量仪〈5°为阴性，5°～7°为阳性，〉7°为明显阳性。结果脊柱测量5例为阴性，39例为阳性，12例为明显阳性；前屈试验有8例为阴性，26例为阳性，22例为明显阳性。Cobb角检测，9例为阴性，36例为阳性，11例为明显阳性。脊柱测量、前屈试验的结果与Cobb角作等级相关分析，Spearman检验系数分别为0．48和0．57，P〈0．05，为正相关。前屈试验、脊柱测量仪与Cobb角检查出的阳性率，作X^2检验，X^2值分别为0．069和1．306，P值分别〉0．74和0．10，检查出的阳性率差异无显著性意义。结论脊柱测量仪和前屈试验在普查中易于实行。当前屈试验阳性，脊柱测量仪大于5°，可视为作X线片检查的指征。

Objective To estimate the sensitivity and specificity of the Scoliometer （Orthopedic Systems INC,OSI 1995）and Adam＇s forward bend test in the screening scoliosis. Methods One examiner independently assessed 56 patients presenting to a scoliosis clinic for trunk asymmetry with Adam＇s forward bend test and axial trunk rotation with the scoliometer. The forward bend test, Scoliometer and Cobb＇s angle were scaled as negative,positive and significantly positive, respectively. For the scoliometer,less than 5 degree is negative, 5 to 7 is positive and more than 7 is significantly positive. For forward bend test, if no asymmetry was found, the test was negative; if the asymmetry was significant, the test was significantly positive; if the asymmetry was found, the test is positive. For Cobb＇s angle, the negative was less than 10 degree, positive was 10 to 20 degree, significant positive was more than 20 degree. The Cobb method was taken as the gold standard. The accuracy of Adam＇s forward bend test and Scoliometer were tested by Cobb＇s angle. Results All 56 students were took Adam＇s forward bend test,scoliometer and standard spine x-ray. Of them, fourteen were male, forty-two were female. All students were Han nationality except one Mongolia student. The average age was thirteen with distributing from 9 to 16 years old （SD= 1.76）. By scoliometer,five students were less than 5 degree （negative） ,39 were 5 to 7 degree （positive） and 12 were more than 7 degree （significantly positive）. By Adam＇s forward bend test,8 students were found no asymmetry,26 with asymmetry and 22 with significant asymmetry. By Cobb＇s angle,9 students were under the 10 degree,36 students were 10 to 20 degree and 11 were more than 20 degree. Rank correlation test were performed between Cobb＇s angle and scoliometer and Adam＇s forward bend test, the Spearman coefficients were 0.48 and 0. 57 respectively （P〈0. 05）. To comparing the accuracy of scoliometer and Adam＇s forward bend test, the incidence of positive finding by the two methods were tested by X^2 with Cobb＇s angle and the X^2 value were 0. 069 and 1. 306 respectively （P〉0. 74 and 0. 10）. Conclusions Scoliometer and Adam＇s forward bent have advantage in spinal deformity screen in school in China. Firstly, the two methods are easy to perform for a mount of students during limited time in school screening, especially in countryside. Secondly, no extreme payment is needed for school and students during the screening programs. The third, the accuracy of the two tests are close to Cobb＇s angle. The last,the two test could be a references for further X-ray diagnosis. If the scoliometer is 5 degree or more, and or the forward bending test is＇significant positive, the X-ray would be indicated. This method may be helpful to reduce student＇s X-ray exposition. The authors believe that the two tests remains the better noninvasive clinical test to screen and evaluate scoliosis.