Shin Jong Ki, Lee Jung Sub, Kang Sung Shik, Lee Jae Myung, Youn Bu Hyun
*Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University School of Medicine, Busan†Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University Yangsan Hospital, YangsanDepartments of ‡Naval Architecture and Ocean Engineering§Biologic Sciences, College of Natural Sciences, Pusan National University, Busan, Republic of Korea.
Clin Spine Surg. 2016 Jul;29(6):E282-7. doi: 10.1097/BSD.0000000000000105.
This is a prospective study design.
To test the interobserver and intraobserver reliabilities of 5 specific measures of global cervical sagittal alignment in patients with ankylosing spondylitis (AS), and to suggest a better means of measuring cervical sagittal alignment.
The intraobserver and interobserver reliabilities of several different methods of measuring cervical lordosis have been reported. However, they have not been studied till yet in patients with AS.
Interobserver and intraobserver reliabilities of 5 specific measures of cervical lordosis were evaluated in patients with AS. Eighty patients with AS were allocated to a nonankylosis or an ankylosis group, and the reliabilities of the Cobb C1-C7, Cobb C2-C7, centroid, posterior tangent, and Ishihara index methods were evaluated.
The intraclass and interclass correlation coefficients (ICCs) of all 5 methods were generally high. For the 80 study subjects, ICCs were ≥0.84 (excellent) for all 5 radiographic methods. However, comparison of the ICCs, 95% confidence intervals, and mean absolute differences (MAD) between groups with varying degrees of ankylosis showed that the reliability of lordosis measurements decreased as the severity of ankylosis increased. The 5 methods consistently demonstrated higher ICCs for both interobserver and intraobserver comparisons in the nonankylosis group. However, in the ankylosis group, the Cobb C1-C7 method demonstrated high ICCs for both interobserver and intraobserver comparisons, whereas the other 4 methods had high ICCs only for intraobserver comparisons. The intraobserver MADs were similar for the 5 methods (2.4-3.9), but the interobserver MADs of measurement methods in both groups showed low measurement reliability except for the Cobb C1-C7 methods.
This study provides a reliability analysis of different cervical lordosis measurement methods in AS, and shows that the Cobb C1-C7 method provides a reliable means for measuring cervical lordosis in AS.
这是一项前瞻性研究设计。
测试强直性脊柱炎（AS）患者中5种特定的颈椎矢状面整体排列测量方法的观察者间和观察者内信度，并提出一种更好的测量颈椎矢状面排列的方法。
已有关于几种不同测量颈椎前凸方法的观察者内和观察者间信度的报道。然而，在AS患者中尚未对其进行研究。
评估AS患者中5种特定颈椎前凸测量方法的观察者间和观察者内信度。80例AS患者被分为非强直组或强直组，评估Cobb C1-C7、Cobb C2-C7、质心、后切线和石原指数法的信度。
所有5种方法的组内和组间相关系数（ICC）普遍较高。对于80名研究对象，所有5种影像学方法的ICC均≥0.84（优秀）。然而，比较不同强直程度组之间的ICC、95%置信区间和平均绝对差值（MAD）表明，随着强直严重程度的增加，前凸测量的信度降低。在非强直组中，5种方法在观察者间和观察者内比较中始终显示出较高的ICC。然而，在强直组中，Cobb C1-C7法在观察者间和观察者内比较中均显示出较高的ICC，而其他4种方法仅在观察者内比较中具有较高的ICC。5种方法的观察者内MAD相似（2.4-3.9），但除Cobb C1-C7法外，两组测量方法的观察者间MAD显示测量信度较低。
本研究提供了AS中不同颈椎前凸测量方法的信度分析，并表明Cobb C1-C7法为测量AS患者的颈椎前凸提供了一种可靠的方法。
