Hall Toby, Briffa Kathy, Hopper Diana
School of Physiotherapy, Curtin Innovation Health Research Institute, Curtin University of Technology, Perth, Australia.
J Man Manip Ther. 2010 Sep;18(3):126-31. doi: 10.1179/106698110X12640740712293.
The purpose of this study was to investigate the impact of lower cervical facet joint pain (CFP) on the flexion-rotation test (FRT).
A single blind, comparative group design was used to investigate whether lower CFP influences FRT mobility and examiner interpretation. Twenty-four subjects were evaluated, 12 with cervicogenic headache (age 26-63 years) and 12 with lower CFP (age 44-62 years), confirmed by therapeutic cervical facet joint intervention. A single blinded examiner conducted the FRT, reporting the test state (positive or negative) before measuring range of motion using a goniometer. Subjects with lower CFP were evaluated by the FRT prior to therapeutic intervention and were excluded from analysis if they did not gain complete symptomatic relief following the procedure. Only subjects with immediate complete relief were included.
The average range of unilateral rotation to the limited side during the FRT was 26 and 37.5° for the cervicogenic headache and lower CFP groups respectively. The difference between groups was significant (P<0.01). Sensitivity and specificity for cervicogenic headache diagnosis was 75 and 92% respectively. A receiver operating curve revealed that an experienced examiner using the FRT was able to make the correct diagnosis 90% of the time (P<0.01), with a positive cut-off value of 32°.
These findings provide further evidence for the clinical utility of the FRT in cervical examination and cervicogenic headache diagnosis.
本研究旨在探讨下颈椎小关节疼痛（CFP）对屈伸旋转试验（FRT）的影响。
采用单盲、对比组设计，以研究下颈椎CFP是否会影响FRT的活动度及检查者的判断。对24名受试者进行了评估，其中12名患有颈源性头痛（年龄26 - 63岁），12名患有下颈椎CFP（年龄44 - 62岁），均经颈椎小关节治疗性干预确诊。由一名单盲检查者进行FRT，在使用角度计测量活动范围之前报告试验结果（阳性或阴性）。下颈椎CFP患者在治疗性干预前接受FRT评估，若术后未获得完全症状缓解则被排除在分析之外。仅纳入立即获得完全缓解的患者。
在FRT期间，颈源性头痛组和下颈椎CFP组向受限侧的单侧平均旋转范围分别为26°和37.5°。两组间差异显著（P<0.01）。颈源性头痛诊断的敏感性和特异性分别为75%和92%。一条受试者工作特征曲线显示，经验丰富的检查者使用FRT时，90%的情况下能够做出正确诊断（P<0.01），阳性截断值为32°。
这些发现为FRT在颈椎检查和颈源性头痛诊断中的临床应用提供了进一步的证据。
