Zimmermann Lea Klara, Hülstrunk Christian, Schmitt Benjamin, Baron Gaby, Roth Rebecca, Hennes Axel, Raab Peter, Zabar Omar
University of Würzburg, Wurzburg, Germany.
Orthopädische Klinik König-Ludwig-Haus, Würzburg, Germany.
Eur Spine J. 2025 Jun 4. doi: 10.1007/s00586-025-09007-4.
The current gold standard in scoliosis diagnostics remains the measurement of the curvature angle using X-ray imaging. Several studies have already shown that children and adolescents with scoliosis suffer from health consequences due to cumulative radiation exposure from frequent radiological follow-ups. Ultrasound diagnostics offers a radiation-free alternative for imaging scoliosis. Various studies have already shown good reliability and validity of different ultrasound devices and various ultrasound methods for measuring the curvature angle in patients with scoliosis. The aim of this study - investigating secondary hypotheses of our main study on "Assessment of the Efficacy of physiotherapeutic scoliosis-specific exercises (PSSE) for Scoliosis through Ultrasound-Based Imaging Techniques" - was to compare two different ultrasound diagnostic methods for scoliosis with the gold standard, X-ray, and to assess their validity and reliability. The curvature angle can be determined using ultrasound based on either the spinous processes (SP) or the transverse processes (TP). The goal was to find out whether one of the two methods is more valid and should therefore be preferred in clinical practice.
Seventy-one patients with AIS (= adolescent idiopathic scoliosis) (60 females, 11 males, average age 14,79) underwent both an anterior-posterior X-ray of and an ultrasound measurement of the spine by one or two different examiners. The Cobb angle was determined in the X-rays and the ultrasound data were automatically measured by the Scolioscan software using both methods SP and TP.
The SP ultrasound method results are in the range of moderate to excellent reliability with ICC values between 0,702 and 0,900. For the TP ultrasound method results show good reliability with ICC values between 0,888 and 0,893. The different Bland Altman Plot diagrams indicate good agreement between both ultrasound measurements and the X-ray. The scatterplot diagrams also show a very good correlation of the values.
It was shown that both the ultrasound methods TP and SP are valid. Particularly for patients requiring frequent follow-up examinations, ultrasound should be used as a diagnostic tool. The TP method is especially in the lumbar region more accurate, has smaller spread in the confidence intervals, is easier to handle and easier for patients to understand and should therefore be preferred over the SP method.
脊柱侧弯诊断的当前金标准仍然是使用X射线成像测量弯曲角度。多项研究已经表明，患有脊柱侧弯的儿童和青少年因频繁的放射学随访中的累积辐射暴露而遭受健康影响。超声诊断为脊柱侧弯成像提供了一种无辐射的替代方法。多项研究已经表明，不同的超声设备和各种超声方法在测量脊柱侧弯患者的弯曲角度方面具有良好的可靠性和有效性。本研究的目的——调查我们关于“通过基于超声的成像技术评估物理治疗性脊柱侧弯特定运动（PSSE）对脊柱侧弯的疗效”的主要研究的次要假设——是将两种不同的脊柱侧弯超声诊断方法与金标准X射线进行比较，并评估它们的有效性和可靠性。可以基于棘突（SP）或横突（TP）使用超声确定弯曲角度。目标是找出这两种方法中的一种是否更有效，因此在临床实践中应更受青睐。
71例青少年特发性脊柱侧弯（AIS）患者（60名女性，11名男性，平均年龄14.79岁）由一名或两名不同的检查者进行了脊柱的前后位X射线检查和超声测量。在X射线中确定Cobb角，并使用棘突（SP）和横突（TP）两种方法通过Scolioscan软件自动测量超声数据。
棘突超声方法的结果可靠性为中度至优秀，ICC值在0.702至0.900之间。对于横突超声方法，结果显示出良好的可靠性，ICC值在0.888至0.893之间。不同的Bland Altman图表明两种超声测量与X射线之间具有良好的一致性。散点图也显示出数值之间具有非常好的相关性。
结果表明，横突（TP）和棘突（SP）超声方法都是有效的。特别是对于需要频繁随访检查的患者，应将超声用作诊断工具。横突（TP）方法在腰椎区域尤其更准确，置信区间内的离散度更小，操作更简便，患者更容易理解，因此应比棘突（SP）方法更受青睐。
