用中轴线距离法测量脊柱侧凸的研究

Axis-line-distance technique:a new method in scoliosis measurement

目的探讨一种测量脊柱侧凸的新方法(即中轴线距离法,简称中线法)的临床应用价值。方法选择30例特发性脊柱侧弯患者,由6名医师分别独立运用 Cobb 法和中线测量法在医学影像存档和通讯系统(PACS)工作站上对脊柱侧凸程度进行测量,并间隔3周后,每名观测者再对30例患者重复测量1次,对所得测量结果进行配对 t 检验。结果(1)6名医师自身2次测量结果比较:Cobb 法和中线法测量产生的最小差值均是0,最大差值分别是24.00°和12.00 mm,平均差值分别是5.71°±1.54°和(1.95±0.58)mm。采用 Cobb 法测量时,除2名主治医师重复测量结果(36.63°±10.3°与37.13°±10.22°、33.27°±10.09°与35.27°±9.71°)差异无统计学意义(P>0.05)外,其余4名医师重复测量结果分别为39.00°±10.69°与36.50°±10.63°、31.73°±10.96°与37.30°±9.65。、32.03°±7.49°与27.86°±9.00°、29.77°±8.87°与34.20°±7.26°,差异均存在统计学意义(P 值均<0.05)。采用中线法测量时,6名医师重复测量结果[(51.03±15.85)mm 与(50.73±15.50)mm、(52.40±14.88)mm 与(52.70±14.74)mm、(53.77±16.14)mm 与(53.60±15.33)mm、(54.07±15.36)mm 与(54.40±15.07)mm、(51.87±14.67)mm 与(51.77±14.46)mm、(52.93±13.88)mm 与(53.27±15.00)mm]差异均无统计学意义(P 值均>0.05)。(2)6名医师相互间比较:Cobb 法和中线法平均差值分别是5.07°±0.35°和(2.32±0.26)mm。采用Cobb 法测量时,相同年资医师间(36.63°±10.30°与33.27°±10.10°、39.00°±10.69°与31.73°±10.96°、32.03°±7.49°与29.78°±8.87°)及不同年资医师间(36.63°±10.30°分别与39.00°± 10.69°、32.03°±7.49°比较,39.00°±10.69°与32.03°±7.49°比较)测量结果差异均有统计学意义(P 值均<0.05)。而采用中线测量法测量,医师1分别与医师2、3[(51.03±15.85)mm 分别与(52.40±14.88)mm、(53.77±16。33)mm]及医师3与医师5[(53.77±16.14)mm 与(51.87±14.67)mm]间比较,差异均存在统计学意义(P 值均<0.05),医师5分别与医师1、6[(51.87±14.67)mm 分别与(51.03±15.85)mm、(52.93±13.88)mm]及医师3与医师4[(53.77±16.14)mm与(54.00±15.36)mm]间比较,差异无统计学意义(P 值均>0.05)。差异与测量者经验无直接相关。结论与 cobb 法相比,中线法具有测量点明确、操作方便、测量结果误差小、重复性好等优点,值得临床试用和推广。

Objective To investigate the clinical significance of a new method, axis-line-distance technique （ALDT）, in scoliosis measurement. Methods Thirty cases with idiopathic scoliosis were measured on two separate occasions by six observers with the Cobb technique and the ALDT on PACS workstation. The interval time between two measurement occasions were three weeks. The data were analyzed statistically with the paired-sample t-test. Results （1） Concerning intraobserver variance in two measurement occasions, the minimum variance , the maximum variance and the average variance were 0, 24.00° ,5.71° ± 1.54° for Cobb technique and 0 , 12. 00 mm , （ 1.95 ±0. 58 ） mm for ALDT. There were significant measurement differences for four observers with Cobb method 39. 00° -± 10. 69° versus 36.50° ± 10. 63 ° , 31.73 ° ± 10. 96° versus 37.30° ± 9. 65°, 32.03 ° ± 7.49 ° versus 27.86° ± 9.00°,29. 77 ° ± 8.87 ° versus 34. 20° ± 7. 26°, all P 〈 0. 05, except two attending physicians 36.63° ± 10. 3° versus 37. 13° ± 10. 22° ,33.27° ±- 10. 09° versus 35.27° ±9. 71°. But there were no significant measurement differences for every observer with ALDT[ （51.03 ± 15.85） mm versus （50.73 _ 15.50） mm, （52.40 ± 14.88） mm versus （52.70±14.74） mm,（53.77 ±16.14） mmversus （53.60±15.33） mm,（54.07±15.36） mm versus （54.40 ± 15.07 ） mm, （51.87 ± 14. 67 ） mm versus （ 51.77 ± 14.46 ） mm, （ 52.93 ± 13.88 ） mm versus （53.27 ± 15. 00） mm,all P 〉0. 05 ]. （2） Concerning interobserver variances in six observers, the average measurement variance was 5.07° ± 0. 35°for Cobb method, and （2. 32 ± 0. 26） mm for ALDT . There were significant measurement differences for every observer using with Cobb method （36. 63° ± 10. 30° versus 33.27° ± 10. 10°, 39.00°± 10. 69° versus 31.73° ± 10. 96°, 32.03° ± 7.49° versus 29. 78° ± 8. 87° ,36. 63° ± 10. 30° versus 39. 00°±10. 69° versus 32.03° ±7.48° ,39. 00° ± 10. 69° versus 32. 03° ± 7.49° ,all P 〈0. 05 ）. The measurement difference from interobserver using with ALDT was significant （the first versus second or third observer, the third versus fifth observer） , or no （ the fifth versus first or sixth observer, the third versus fourth observer）, which is not a direct relationship between the experience of the observer. Condtmion The ALDT is worth applying and spreading, because it is more simple , more reliable and less error than the Cobb technique, as well as showing better intraobserver or interobserver reproducibility.