Rey-Eiriz Gerardo, Alburquerque-Sendín Francisco, Barrera-Mellado Inmaculada, Martín-Vallejo Francisco J, Fernández-de-las-Peñas César
Osteopathic School of Madrid, Spain.
J Manipulative Physiol Ther. 2010 May;33(4):279-85. doi: 10.1016/j.jmpt.2010.03.005.
The purpose of this study was to determine if the posterior-anterior cervical gliding test is a valid test as compared with dynamic radiographic assessment in flexion/extension as tool for the manual diagnosis of intervertebral joint hypomobility in the midcervical spine in patients with mechanical neck pain.
The study was done according to Standards for Reporting of Diagnostic Accuracy guidelines. Fifty patients with mechanical neck pain participated. An examiner performed a posterior-anterior cervical spine gliding to determine the presence of joint hypomobility over the C3-C4, C4-C5, and C5-C6 levels. Two dynamic radiographs in flexion/extension of the neck were obtained from each patient. The angle resulting from the intersection of 2 lines traced between 2 consecutive vertebrae was considered the degree of intersegmental motion of flexion-extension between those vertebrae. Intersegmental motion showing radiographic data below mean - SD from normative data was considered to reflect hypomobility. Differences between hypomobile and not hypomobile segments were assessed with the 2-tailed unpaired Student t test. Sensitivity, specificity, positive predictive value, and negative predictive value were also obtained.
At all cervical segments, those patients diagnosed with hypomobility showed significantly (P < .001) lower radiographic motion (C3-C4: 12.4 degrees +/- 2.7 degrees, C4-C5: 14.5 degrees +/- 2.6 degrees, C5-C6: 15.0 degrees +/- 4.8 degrees) compared with those patients not diagnosed with hypomobility (C3-C4: 17.6 degrees +/- 3.8 degrees, C4-C5: 19.4 degrees +/- 3.4 degrees, C5-C6: 21.0 degrees +/- 3.8 degrees). The C3-C4 and C4-C5 levels had high sensitivity (>80%) and specificity (>70%), whereas C5-C6 showed high sensitivity (100%) but low specificity (41%).
The posterior-anterior cervical gliding test was as good as dynamic radiographic assessment for the diagnosis of intervertebral hypomobility in the midcervical spine in this group of subjects.
本研究旨在确定与动态X线评估相比，颈椎后前向滑动试验作为手动诊断机械性颈痛患者中颈椎间关节活动度降低的工具是否有效。
本研究按照诊断准确性报告标准指南进行。50例机械性颈痛患者参与研究。一名检查者进行颈椎后前向滑动，以确定C3-C4、C4-C5和C5-C6节段是否存在关节活动度降低。从每位患者获取两张颈部屈伸位动态X线片。在两个连续椎体之间绘制的两条线相交形成的角度被视为这些椎体之间屈伸节段间运动的程度。节段间运动的X线数据低于正常数据平均值减标准差被认为反映活动度降低。使用双侧非配对Student t检验评估活动度降低节段和非活动度降低节段之间的差异。还获得了敏感性、特异性、阳性预测值和阴性预测值。
在所有颈椎节段，诊断为活动度降低的患者与未诊断为活动度降低的患者相比，X线运动显著更低（P <.001）（C3-C4：12.4度±2.7度，C4-C5：14.5度±2.6度，C5-C6：15.0度±4.8度）（C3-C4：17.6度±3.8度，C4-C5：19.4度±3.4度，C5-C6：21.0度±3.8度）。C3-C4和C4-C5节段具有高敏感性（>80%）和特异性（>70%），而C5-C6节段显示高敏感性（100%）但低特异性（41%）。
在这组受试者中，颈椎后前向滑动试验在诊断中颈椎间关节活动度降低方面与动态X线评估效果相当。
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