Wu Shyi-Kuen, Jou Jia-Yuan, Lee Hsin-Min, Chen Han-Yu, Su Fong-Chin, Kuo Li-Chieh
Department of Physical Therapy, HungKuang University, No. 1018, Sec. 6, Taiwan Blvd, Shalu District, Taichung City 43302, Taiwan.
Department of Physical Therapy, I-Shou University, No. 8, Yida Rd, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan.
Spine J. 2015 May 1;15(5):1083-91. doi: 10.1016/j.spinee.2013.06.097. Epub 2013 Nov 14.
The abnormal translations between vertebrae in the sagittal plane are important clues to spinal dysfunction or instability. Several studies have reported significant variability in their translation measurements with no analysis of data reproducibility.
We sought to determine the intra- and interobserver reproducibility of the computer-assisted geometric midplanes and rotation matrix methods in the measurements of intervertebral translations at different motion ranges of cervical flexion-extension in asymptomatic subjects and disc-herniated patients.
A blind, repeated-measure design was applied to determine the reproducibility for intervertebral translation measurements.
A total of 608 videofluoroscopic image sequences from the different motion ranges of cervical flexion and extension in 38 asymptomatic subjects and 38 disc-herniated patients were digitized for further analysis.
The intra- and interobserver reproducibility on measuring the sequential translations were in the acceptable range for geometric midplanes method (average intraclass correlation coefficients [ICCs], 0.860 and 0.806; mean absolute difference [MAD] 0.19 and 0.33 mm) and rotation matrix method (average ICCs, 0.807 and 0.735; MAD, 0.35 and 0.42 mm). There was significantly better reproducibility on the measurements of intervertebral translation for the geometric midplanes method than those of rotation matrix method (p=.001-.040). The absolute mean differences of the translation measurements between two image protocols averaged 11.2% and 10.8% for the asymptomatic subjects and disc-herniated patients, respectively.
Based on these results, both methods demonstrated acceptable reproducibility on the intervertebral translation measurements. The geometric midplanes method involving an averaging effect on the placements of vertebral landmarks and closer to center of rotation might reduce the errors in translation estimations. The rotation matrix protocol simultaneously illustrated horizontal and vertical translation motion despite greater digitizing and/or measurement errors.
矢状面椎体间的异常平移是脊柱功能障碍或不稳定的重要线索。多项研究报告了其平移测量存在显著变异性，但未对数据的可重复性进行分析。
我们试图确定计算机辅助几何中间平面和旋转矩阵方法在测量无症状受试者和椎间盘突出症患者颈椎屈伸不同运动范围内椎间平移时观察者内和观察者间的可重复性。
采用盲法重复测量设计来确定椎间平移测量的可重复性。
对38名无症状受试者和38名椎间盘突出症患者颈椎屈伸不同运动范围的608个视频荧光透视图像序列进行数字化处理，以进行进一步分析。
几何中间平面法测量连续平移时观察者内和观察者间的可重复性在可接受范围内（平均组内相关系数[ICC]分别为0.860和0.806；平均绝对差[MAD]分别为0.19和0.33毫米），旋转矩阵法（平均ICC分别为0.807和0.735；MAD分别为0.35和0.42毫米）。几何中间平面法测量椎间平移的可重复性明显优于旋转矩阵法（p = 0.001 - 0.040）。无症状受试者和椎间盘突出症患者两种图像方案之间平移测量的绝对平均差分别平均为11.2%和10.8%。
基于这些结果，两种方法在椎间平移测量中均显示出可接受的可重复性。几何中间平面法对椎体标志点的放置具有平均效应且更接近旋转中心，可能会减少平移估计中的误差。旋转矩阵方案尽管存在更大的数字化和/或测量误差，但能同时显示水平和垂直平移运动。
