Lundon K M, Li A M, Bibershtein S
Department of Physical Therapy, University of Toronto, Canada.
Spine (Phila Pa 1976). 1998 Sep 15;23(18):1978-85. doi: 10.1097/00007632-199809150-00013.
A reliability study was performed using repeated random measurements involving three observers, 26 subjects and three instruments.
To determine the most reliable, cost-effective, noninvasive, and clinically feasible method of measuring spinal kyphosis.
The most clinically useful, noninvasive and reliable method of measuring postural deformity in spinal osteoporosis (kyphosis) remains unqualified. Despite traditional use of costly, invasive roentgenographs for the evaluation of spinal kyphosis, the reliability of this method remains questionable.
Twenty-six postmenopausal women with known bone mineral density and a diagnosis of osteoporosis were recruited from the Osteoporosis Program at Women's College Hospital, Toronto, Canada. Non-invasive measurements of thoracic kyphosis were obtained by three trained examiners using the DeBrunner's kyphometer and the flexicurve ruler. The intrarater and interrater reliability of and between each method was compared, using roentgenographic films obtained in the sagittal plane. Spinal posture was classified according to the method of Itoi (1990). Statistical computations were performed using SAS statistical software.
Consistent measurements were obtained with the DeBrunner's kyphometer and the flexicurve ruler by each observer, according to the results of critical two-way analysis of variance (Intraclass Correlation Coefficient 2, 1). Measurements in two subgroups, healthy backs (n = 11) and rounded backs (n = 13), showed consistent use of each noninvasive instrument with some examiner preference for specific tools. There was marginally better intrarater and interrater reliability using the DeBrunner's kyphometer compared with that obtained with the flexicurve ruler. Two-way analysis of variance (Intraclass Correlation Coefficient 2, 1) of collapsed data showed no significant difference in the reliability of the kyphometer, flexicurve ruler, or roentgenographs in the measurement of thoracic kyphosis.
The flexicurve ruler and DeBrunner's kyphometer had the closest agreement in the measurement of spinal kyphosis. The kyphometer demonstrated the least variation in intrarater and interrater reliability when compared with the flexicurve ruler and roentgenographs. The flexicurve ruler permits qualitative assessment of posture, however, and is the most cost-effective instrument. The results of this study challenge the traditional belief that roentgenographic analysis is the best method for evaluating spinal kyphosis. The DeBrunner's kyphometer and flexible ruler may represent viable, cost-effective and noninvasive alternatives to roentgenographic evaluation of spinal kyphosis.
采用重复随机测量方法进行可靠性研究，涉及三名观察者、26名受试者和三种仪器。
确定测量脊柱后凸最可靠、最具成本效益、无创且临床可行的方法。
在脊柱骨质疏松症（后凸畸形）中，测量姿势畸形最具临床实用性、无创且可靠的方法仍未明确。尽管传统上使用昂贵的侵入性X线片来评估脊柱后凸，但该方法的可靠性仍存在疑问。
从加拿大多伦多女子学院医院的骨质疏松项目中招募了26名已知骨密度且诊断为骨质疏松症的绝经后女性。三名经过培训的检查者使用德布鲁纳后凸测量仪和柔性曲线尺对胸椎后凸进行无创测量。使用矢状面的X线片比较每种方法内部和之间的评分者内及评分者间可靠性。根据糸井（1990年）的方法对脊柱姿势进行分类。使用SAS统计软件进行统计计算。
根据关键的双向方差分析结果（组内相关系数2,1），每位观察者使用德布鲁纳后凸测量仪和柔性曲线尺都获得了一致的测量结果。在两个亚组中，健康背部（n = 11）和圆背（n = 13）的测量结果表明，每种无创仪器的使用都具有一致性，一些检查者对特定工具有所偏好。与柔性曲线尺相比，使用德布鲁纳后凸测量仪的评分者内及评分者间可靠性略好。汇总数据的双向方差分析（组内相关系数2,1）表明，后凸测量仪、柔性曲线尺或X线片在测量胸椎后凸的可靠性方面没有显著差异。
在测量脊柱后凸方面，柔性曲线尺和德布鲁纳后凸测量仪的一致性最高。与柔性曲线尺和X线片相比，后凸测量仪在评分者内及评分者间可靠性方面的差异最小。然而，柔性曲线尺允许对姿势进行定性评估，并且是最具成本效益的仪器。本研究结果挑战了传统观念，即X线分析是评估脊柱后凸的最佳方法。德布鲁纳后凸测量仪和柔性尺可能是脊柱后凸X线评估的可行、具成本效益且无创的替代方法。
