动态骨骼肌肉综合分析系统测量颈椎活动度的重复性和可靠性分析

Measurement of cervical range of motion by Comprehensive Musculoskeletal Analysis System:Repeatability and reliability analysis

目的提出一种采用动态骨骼肌肉综合分析系统(comprehensive musculoskeletal analysis system,CMAS)测量颈椎活动度(range of motion,ROM)的新方法,并探讨其测量的重复性和可靠性。方法选择本院脊柱外科门诊就诊的颈部疼痛患者为研究对象,分别采用CMAS测量和DSA动态影像测量颈椎ROM。50名受试者采用CMAS进行测量(A组),15名受试者同时采用动态X线(DSA,数字减影血管造影机)影像进行测量(B组)。对两组测量结果进行比较、相关性分析;对A组进行观察者内、观察者间一致性分析。采用测量标准误(standard error of measurement,SEM)和最小可检测变化(minimum detectable change,MDC)对两种测量方法进行可靠性分析。结果两种测量方法在两组不同性别、年龄分组的比较中,差异无统计学意义(P>0.05);A组观察者内一致性分析ICC=0.947,95%CI(0.763,0.980),P<0.01,两次测量具有高度一致的观察者内一致性;观察者间一致性分析ICC=0.899,95%CI(0.799,0.947),P<0.01,不同测量者测量具有高度一致的观察者间一致性。A组颈椎ROM测量的SEM为3.0°,MDC为6.9°;B组SEM为1.8°,MDC为4.1°;相关性分析显示,两种测量方法具有显著相关性(P<0.01),相关系数为0.758;Bland-Altman分析显示,两种测量方法的平均差值为0.29°,差值分布接近于0,所有测量的数据点均在95%CI内。结论CMAS测量颈椎ROM具有良好的重复性和可靠性,是用于测量颈椎ROM的有效方法。

Objective To propose a new method of measuring the cervical range of motion(ROM)by Comprehensive Musculoskeletal Analysis System(CMAS),and investigate the repeatability and reliability.Methods The patients with neck pain in spine surgery clinic of our hospital were included.The ROM of cervical spine was measured by CMAS and the dynamic image of DSA.50 patients were measured with CMAS(Group A).15 patients were also measured with dynamic X-ray(DSA,digital subtraction angiography)images(Group B).The measurement results of the two groups were compared andcorrelative analyzed.Intra-observer and inter-observer consistency of Group A were analyzed.Reliability of the two methods were analyzed using Standard error of measurement(SEM)and minimum detectable change(MDC).Results There was no significant difference between the two methods in different gender and age groups(P>0.05).Intra-observer consistency analysis of Group A showed high degree,ICC=0.947,95%CI(0.763,0.980),P<0.01.Inter-observer consistency analysis also showed high degree,ICC=0.899,95%CI(0.799,0.947),P<0.01.For Group A,SEM and MDC were 3.0°and 6.9°respectively,and SEM and MDC were 1.8°and 4.1°respectively for Group B.Correlation analysis showed that the two methods had significant correlation(P<0.01),and the correlation coefficient was 0.758.Bland Altman analysis showed that the average difference between the two methods was 0.29°.The BlandAltman plots demonstrated that most of the data were within the 95%consistency limit.Conclusion The measurement of cervical ROM with CMAS has good repeatability and reliability,and is an effective method for measuring cervical ROM.