颈椎矢状面活动度影像学改良测量方法的初步应用

Preliminary application of a modified imaging measurement method for sagittal range of motion of cervical spine

目的提出一种改良颈椎矢状面活动度(ROM)影像学测量方法,并与传统测量方法进行比较。方法纳入接受颈椎前路椎间盘切除融合术(ACDF)治疗的72例颈椎病患者为研究对象,其中脊髓型颈椎病(CSM)43例,神经根型颈椎病(CSR)29例。利用术前颈椎仰伸位与屈曲位侧位X线片,由2名脊柱外科医师分别采用传统测量法和改良测量法对颈椎ROM进行测量。分析2种测量方法的观察者内一致性、观察者间一致性,并对2种测量方法的结果进行相关性分析和比较。结果按性别、年龄、病种分层,2种方法测量的颈椎ROM差异均无统计学意义(P>0.05),且2种方法测量的颈椎ROM均随年龄的增大而下降。传统方法和改良方法均具有高度观察者内一致性(组内相关系数分别为0.961、0.991)和观察者间一致性(组内相关系数分别为0.964、0.993),且改良方法的观察者内一致性和观察者间一致性高于传统方法。2种方法的测量结果呈高度正相关(r=0.987,P<0.01)。对2种方法前后2次测量结果的差值进行比较,结果显示,2种方法不同测量者之间2次测量结果的差值差异均无统计学意义(P>0.05);而对无论哪名测量者,不同方法之间2次测量结果的差值差异均有统计学意义(P<0.01)。结论改良方法测量颈椎ROM具有高度观察者内一致性和观察者间一致性,采用改良方法能够提高颈椎ROM测量的精准度。

Objective To propose a modified imaging measurement method for sagittal range of motion(ROM)of cervical spine and compare it with the traditional measurement method.Methods A total of 72 patients who underwent anterior cervical decompression and fusion(ACDF)for cervical spondylosis were selected,including 43 cases of cervical spondylotic myelopathy(CSM)and 29 cases of cervical spondylotic radiculopathy(CSR).Preoperative flexion and extension cervical radiographs were used to perform the measurement by 2 spine surgeons using traditional cervical ROM measurement and modified cervical ROM measurement,respectively.Intra-observer consistency and inter-observer consistency of the 2 methods were analyzed,and the results of the 2 methods were analyzed and compared.Results There was no significant difference between the 2 methods in different gender,age and disease groups.With the increase of age,the ROM of cervical spine decreased significantly.Both the traditional measurement method and the modified measurement method showed a high degree of intra-observer consistency(intraclass correlation coefficient being 0.961 and 0.991)and a high degree of inter-observer consistency(intraclass correlation coefficient being 0.964 and 0.993),and the intra-observer and inter-observer consistencies of the modified measurement method were higher than those of the traditional measurement method.There was a significant correlation between the 2 methods(r=0.987,P<0.01).The difference of the repeated measurements between the 2 methods was compared.The results showed that the difference of the repeated measurements between different measurers either using the traditional measurement method or the modified measurement method was not statistically significant(P>0.05),and the difference of the repeated measurements between different methods was statistically significant(P<0.01).Conclusions The modified measurement method has high intra-observer consistency and inter-observer consistency.Accuracy of ROM measurement of cervical spine can be improved by using the modified measurement method.