Department of Orthopaedic Surgery, Dartmouth-Hitchcock Metical Center, Lebanon, NH 03756, USA.
Spine (Phila Pa 1976). 2011 Apr 1;36(7):572-80. doi: 10.1097/BRS.0b013e3181e11c13.
Comparison of intra- and interobserver reliability of digitized manual and computer-assisted intervertebral motion measurements and classification of "instability."
To determine if computer-assisted measurement of lumbar intervertebral motion on flexion-extension radiographs improves reliability compared with digitized manual measurements.
Many studies have questioned the reliability of manual intervertebral measurements, although few have compared the reliability of computer-assisted and manual measurements on lumbar flexion-extension radiographs.
Intervertebral rotation, anterior-posterior (AP) translation, and change in anterior and posterior disc height were measured with a digitized manual technique by three physicians and by three other observers using computer-assisted quantitative motion analysis (QMA) software. Each observer measured 30 sets of digital flexion-extension radiographs (L1-S1) twice. Shrout-Fleiss intraclass correlation coefficients for intra- and interobserver reliabilities were computed. The stability of each level was also classified (instability defined as >4 mm AP translation or 10° rotation), and the intra- and interobserver reliabilities of the two methods were compared using adjusted percent agreement (APA).
Intraobserver reliability intraclass correlation coefficients were substantially higher for the QMA technique THAN the digitized manual technique across all measurements: rotation 0.997 versus 0.870, AP translation 0.959 versus 0.557, change in anterior disc height 0.962 versus 0.770, and change in posterior disc height 0.951 versus 0.283. The same pattern was observed for interobserver reliability (rotation 0.962 vs. 0.693, AP translation 0.862 vs. 0.151, change in anterior disc height 0.862 vs. 0.373, and change in posterior disc height 0.730 vs. 0.300). The QMA technique was also more reliable for the classification of "instability." Intraobserver APAs ranged from 87 to 97% for QMA versus 60% to 73% for digitized manual measurements, while interobserver APAs ranged from 91% to 96% for QMA versus 57% to 63% for digitized manual measurements.
The use of QMA software substantially improved the reliability of lumbar intervertebral measurements and the classification of instability based on flexion-extension radiographs.
数字化手动和计算机辅助椎间运动测量的观察者内和观察者间可靠性比较，以及“不稳定”的分类。
确定在屈伸位 X 光片上使用计算机辅助测量腰椎运动是否比数字化手动测量更可靠。
许多研究都对手动椎间测量的可靠性提出了质疑，尽管很少有研究比较过屈伸位 X 光片上计算机辅助测量和手动测量的可靠性。
三位医生使用数字化手动技术，三位其他观察者使用计算机辅助定量运动分析（QMA）软件，对椎间旋转、前后（AP）移位以及前、后椎间盘高度的变化进行了测量。每位观察者对 30 组数字屈伸位（L1-S1）进行了两次测量。计算了观察者内和观察者间可靠性的 Shroout-Fleiss 组内相关系数。还对每个节段的稳定性进行了分类（不稳定定义为>4mm AP 移位或 10°旋转），并使用调整后的百分比一致性（APA）比较了两种方法的观察者内和观察者间可靠性。
在所有测量中，QMA 技术的观察者内可靠性组内相关系数均明显高于数字化手动技术：旋转 0.997 对 0.870，AP 移位 0.959 对 0.557，前椎间盘高度变化 0.962 对 0.770，后椎间盘高度变化 0.951 对 0.283。观察者间可靠性也呈现相同的模式（旋转 0.962 对 0.693，AP 移位 0.862 对 0.151，前椎间盘高度变化 0.862 对 0.373，后椎间盘高度变化 0.730 对 0.300）。在屈伸位 X 光片上，“不稳定”的分类中，QMA 技术也更可靠。QMA 的观察者内 APA 范围为 87%至 97%，而数字化手动测量的范围为 60%至 73%，QMA 的观察者间 APA 范围为 91%至 96%，而数字化手动测量的范围为 57%至 63%。
使用 QMA 软件可显著提高腰椎椎间运动测量和基于屈伸位 X 光片的不稳定分类的可靠性。
