Rillardon L, Levassor N, Guigui P, Wodecki P, Cardinne L, Templier A, Skalli W
Service de Chirurgie Orthopédique, Hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy.
Rev Chir Orthop Reparatrice Appar Mot. 2003 May;89(3):218-27.
Parameters determining sagittal balance are essential for optimal analysis and treatment of many spinal disorders. The purpose of this work was to validate a software designed to measure the principal parameters involved in sagittal balance of the spine.
Six parameters (lumbar lordosis, thoracic kyphosis, sagittal tilt at T9, pelvic index, pelvic tilt, slope of the sacrum) were measured on lateral views of the spine from 100 healthy volunteers free of any spinal disease. Two measurement techniques were used: manual measurement and automatic computerized measurement with this software. We hypothesized that manual measures could be accepted as reference values because they are currently the most widely used and because the computerized measurements were obtained using digitalized images that may have modified interpretation. The software was therefore validated by comparing the angles measured manually with the computer output. Inter- and intraobserver coefficients of variation were calculated for the two measurement techniques. One operator performed both series of measurements (manual and computerized). Two other operators preformed two series of independent measures using one of the measurement techniques. Finally, two new operators performed a complete series of measurements using both measurement techniques. Comparisons were performed with the t test for paired variables with calculation of the coefficients of correlation. Intraclass coefficients of correlation were determined for inter- and intra-observer variability.
There was an excellent correlation between the manual measurements and the computerized measurements with intra-class coefficients of correlation varying from 0.82 to 0.96. Inter- and intra-observer variabilities were comparable for the two measurement techniques used to determine thoracic kyphosis, lumbar lordosis, pelvic index, pelvic tilt, and slope of the sacrum. Inter- and intra-observer variability was lower when the sagittal tilt was measured with the software specially designed.
This comparison between two techniques for measuring pelvic and spinal parameters of sagittal balance of the spine demonstrated a good correlation between manual and the computerized measurements obtained with the software to be evaluated. Computer-assisted measurements not only provided a saving in time but also minimized inter- and intra-observer variability for the estimation of certain parameters.
确定矢状面平衡的参数对于许多脊柱疾病的最佳分析和治疗至关重要。本研究的目的是验证一款用于测量脊柱矢状面平衡主要参数的软件。
从100名无任何脊柱疾病的健康志愿者的脊柱侧位片上测量六个参数（腰椎前凸、胸椎后凸、T9矢状面倾斜度、骨盆指数、骨盆倾斜度、骶骨斜率）。使用了两种测量技术：手动测量和使用该软件进行自动计算机测量。我们假设手动测量可被视为参考值，因为它们目前使用最为广泛，且计算机测量是通过数字化图像获得的，这可能会改变测量结果的解读。因此，通过将手动测量的角度与计算机输出结果进行比较来验证该软件。计算了两种测量技术的观察者间和观察者内变异系数。一名操作人员进行了这两种测量（手动和计算机测量）。另外两名操作人员使用其中一种测量技术进行了两组独立测量。最后，两名新操作人员使用两种测量技术进行了完整的测量。使用配对变量的t检验并计算相关系数进行比较。确定了观察者间和观察者内变异的组内相关系数。
手动测量与计算机测量之间存在极好的相关性，组内相关系数在0.82至0.96之间。用于确定胸椎后凸、腰椎前凸、骨盆指数、骨盆倾斜度和骶骨斜率的两种测量技术的观察者间和观察者内变异性相当。使用专门设计的软件测量矢状面倾斜度时，观察者间和观察者内变异性较低。
对测量脊柱矢状面平衡的骨盆和脊柱参数的两种技术进行的比较表明，手动测量与使用待评估软件获得的计算机测量之间具有良好的相关性。计算机辅助测量不仅节省了时间，而且在估计某些参数时将观察者间和观察者内变异性降至最低。
