颈椎曲度和活动度的测量及意义

如何准确测量颈惟曲度和活动度一直是基础和临床研究中很棘手的问题 ,本文就常用的曲度和活动度测量方法及意义作一简述 ;常用的屈度测量方法有 Borden氏法、改良 Borden氏法和夹角测量法等 ,值得推荐的是 Borden氏法 ;颈椎活动度的测量方法相对较多 ,有颈椎动力性摄片法、改良方盘测角仪、脊柱运动分析仪、颈椎活动度测量仪、电动测量仪、皮尺测量和目测等数十种 ,但目前尚无一种切实可靠、能被大多数研究人员公认的活动度测量方法 ;颈椎曲度和活动度的变化能准确地反应颈椎整体功能的变化 ,当颈椎病初发或颈椎病产生症状时 ,往往都有颈椎曲度和活动度的变化 ,颈椎曲度和活动度的变化对颈椎病的早期诊断、对判定颈椎各节段功能及颈椎病变部位都有一定的积极意义     

6种颈椎曲度测量方法的可信度及可重复性比较

目的 :比较6种颈椎曲度测量方法的可信度及可重复性。方法 :随机选取在我科接受颈椎X线检查的80例患者进行标准颈椎侧位拍片,由3名放射科医生采用基于距离[1Borden氏测量法;2颈椎曲度指数(CCI)法;3椎体质心测量法(CCL)测量方法]和基于角度(1C1-C7 Cobb角测量法;2C2-C7 Cobb角测量法;3Harrison氏测量法)共6种测量方法分别测量颈椎曲度。以2周为间隔分别独自测量两次,对测量结果进行统计分析。结果:6种测量方法均具有良好的可信度(r=0.752~0.968)和可重复性(r=0.703~0.915)。基于距离的测量方法中可信度以Borden氏测量法最高(r=0.938~0.968),其次为CCL法(r=0.855~0.908)及CCI法(r=0.775~0.821);可重复性以Borden氏测量法最好(r=0.888~0.915),其次为CCI法(r=0.819~0.862)及CCL法(r=0.810~0.859)。基于角度的测量方法中可信度以C2-C7 Cobb角测量法最高(r=0.871~0.895),其次为Harrison氏法(r=0.830~0.885)及C1-C7 Cobb角测量法(r=0.752~0.836);可重复性以Harrison氏法最好(r=0.868~0.880),其次为C2-C7 Cobb角测量法(r=0.859~0.876)及C1-C7 Cobb角测量法(r=0.703~0.837)。结论 :6种不同的颈椎曲度测量方法均具有良好的可信度及可重复性。基于距离的曲度测量方法以Borden氏测量法可信度及可重复性最好,基于角度的曲度测量方法以C2-C7 Cobb角测量法可信度最高,以Harrison氏法可重复性最好。     

颈前路减压融合术后椎间高度四种测量方法的可靠性研究

目的 评价颈前路减压融合术后椎间高度变化的四种测量方法的可靠性。方法 由2名医师分别采用前椎间隙高度直接测量法、椎间隙高度指数法、盘-椎比值法、颈前柱高度测量法，测量68例脊髓型颈椎病手术前后颈椎X线侧位片的椎间高度，计算相应结果，再进行相关性分析。结果 以颈前柱高度测量法的相关系数(0．836)最大，前椎间隙高度直接测量法相关系数(0．639)最小。结论 四种测量方法中．以颈前柱高度测量法最为可靠，测量方法简单实用。     

Borden氏法与Harrison氏法测量颈椎曲度的一致性比较

【摘要】 目的：比较Borden氏法与Harrison氏法测量颈椎曲度的一致性。方法：从2009年1月~2010年12月在我院体检中心接受颈椎X线片检查者中,筛选出近6个月内无颈肩部疼痛、X线片显示颈椎结构清晰完整且无颈椎骨折、感染、肿瘤、畸形、脱位等异常者205例,男93例,女112例,年龄15~79岁,平均38.3岁。在侧位X线片上分别用Borden氏法、Harrison氏法测量颈椎曲度,每种方法测量均由2位骨科医师分别进行,每位医师重复测量3次,测量结果取平均值。Borden氏法所测量的颈椎曲度深度值以相对值（颈椎曲度深度实测值/C4椎体矢状位前后径实测值）表示。对同一测量方法2位医师的测量结果进行配对t检验,了解不同测量人员在使用同一方法测量时所得数据的一致性,从而比较两种方法重复测量的一致性。结果：2位医师用Harrison氏法测得的颈椎曲度分别为33.0°±11.5°、34.8°±11.7°,两组数据之间有显著性差异（P＜0.01）;2位医师用Borden氏法测得的颈椎曲度分别为0.79±0.27、0.77±0.27,两组数据之间无显著性差异（P＞0.01）。结论：Borden氏法测量颈椎曲度的一致性较Harrison氏法好。     

颈椎矢状面活动度影像学改良测量方法的初步应用

目的 提出一种改良颈椎矢状面活动度(ROM)影像学测量方法,并与传统测量方法进行比较.方法 纳入接受颈椎前路椎间盘切除融合术(ACDF)治疗的72例颈椎病患者为研究对象,其中脊髓型颈椎病(CSM)43例,神经根型颈椎病(CSR)29例.利用术前颈椎仰伸位与屈曲位侧位X线片,由2名脊柱外科医师分别采用传统测量法和改良测量法对颈椎ROM进行测量.分析2种测量方法的观察者内一致性、观察者间一致性,并对2种测量方法的结果进行相关性分析和比较.结果 按性别、年龄、病种分层,2种方法测量的颈椎ROM差异均无统计学意义(P>0.05),且2种方法测量的颈椎ROM均随年龄的增大而下降.传统方法和改良方法均具有高度观察者内一致性(组内相关系数分别为0.961、0.991)和观察者间一致性(组内相关系数分别为0.964、0.993),且改良方法的观察者内一致性和观察者间一致性高于传统方法.2种方法的测量结果呈高度正相关(r=0.987,P<0.01).对2种方法前后2次测量结果的差值进行比较,结果显示,2种方法不同测量者之间2次测量结果的差值差异均无统计学意义(P>0.05);而对无论哪名测量者,不同方法之间2次测量结果的差值差异均有统计学意义(P<0.01).结论 改良方法测量颈椎ROM具有高度观察者内一致性和观察者间一致性,采用改良方法能够提高颈椎ROM测量的精准度.     

肩胛肌筋膜炎软组织张力与颈椎生理曲度改变相关性探讨

目的：探讨肩胛肌筋膜炎患者颈椎曲度改变与软组织张力之间的相关性。方法：2012年2月至2012年12月门诊确诊肩胛肌筋膜炎患者29例,男10例,女19例;年龄22~40岁,平均27．77岁。常规拍摄颈椎正侧位X线片,并采用Borden测量法对颈椎生理曲度进行测量,用软组织张力仪测量患者痛点张力。最后对上述数值进行统计分析。结果：29例肩胛肌筋膜炎患者的侧位X线表现：颈椎生理曲度正常者9例,颈椎生理曲度减小者18例,颈曲颈椎生理曲度增大者2例。颈椎生理曲度改变D值（Y）对软组织张力位移D0.5kg（X）的回归方程Y=-15．069＋3．673X。结论：颈椎生理曲度改变与软组织张力之间具有相关性,可用线性回归方程表示。随着软组织张力的增加,颈椎生理曲度有减小的趋势。     

三种方法恢复颈椎生理曲度及椎间高度的比较

目的　分析颈前路减压术中不同撑开技术对恢复颈椎生理曲度及椎间高度的影响。方法　 1995 .7— 2 0 0 1.3月间施术的颈椎病患者 5 4例 ,按照术中椎间隙牵开方法的不同分为徒手牵开组、Cage牵开组及牵开器牵开组等三种。分别测量各组术前、术后颈椎生理曲度及椎节高度值 ,测量结果进行统计学比较。结果　牵开器牵开法及Cage牵开法较徒手牵开法颈椎生理曲度及椎节高度增加值大 ,且具显著性差异 (P <0 .0 1)。结论　术中牵开技术可影响颈椎生理曲度及椎节高度的恢复 ,牵开器牵开法对改善颈椎生理曲度及椎节高度较为理想。     

颈椎曲度的测量方法及其临床意义

颈椎曲度的测量是临床上评价颈椎功能的基本方法和确定治疗方案的重要参考指标,然而针对不同情况下如何选择合适的测量方法,以及各测量方法间的相关性研究尚不充分.越来越多的研究表明,使用不同的测量方法可直接影响颈椎异常曲度的判断.因此,通过颈椎曲度测量方法的比较研究,对不同颈椎曲度条件下颈椎病变的临床治疗有着重要的意义.     

无症状成人不同曲度颈椎矢状面参数相关性分析

目的探讨无症状成人不同曲度颈椎矢状面参数相关性。方法分析180例无症状成人颈椎DR正、侧位片影像学资料,根据Borden测量法将体检者分为前凸组(120例)和非前凸组(60例)。比较矢状面各参数:C_0～C_2 Cobb角、C_2～C_7 Cobb角、T1倾斜角(TS)、胸廓入口角(TIA)、C_2～C_7椎体矢状面垂直距离(C_2～C_7 SVA)。采用Pearson相关系数分析颈椎矢状面各参数的相关性。结果 C_2～C_7 Cobb角、TS两组比较差异均有统计学意义(P 0.01)。分析颈椎矢状面各参数的相关性:①前凸组:C_0～C_2 Cobb角与C2～C7Cobb角呈负相关,与C_2～C_7 SVA呈正相关; C_2～C_7Cobb角、TIA均与TS呈正相关; TIA、TS均与C_2～C_7 SVA呈负相关。②非前凸组:TIA与TS、C0～C2Cobb角与C2～C7SVA呈正相关; C_2～C_7 Cobb角与C_2～C_7 SVA呈负相关。结论无症状成人不同曲度颈椎矢状面参数相关性不同,提示不同曲度颈椎序列代偿机制可能不同,对于非前凸型成人,建议进行C_2～C_7 Cobb角、TS、TIA测量后综合评估以制定更合适的治疗方案。     

颈脊髓受压程度与椎间隙及颈椎曲度变化的相关性研究

目的:探讨颈脊髓受压程度与性别、年龄、椎间隙及颈椎曲度变化的相关性,应用多元线性回归方法建立预测颈椎病患者颈脊髓受压程度的模型。方法:选取颈椎病患者120例,按照脊髓受压程度分为4组,在颈椎矢状位MRIT2WI成像上测量颈脊髓受压比例,椎间盘后凸顶点脊髓矢状径（a）、延髓与桥脑交界处矢状径（M）,计算a/M值来评估颈脊髓受压程度;在颈椎X线侧位片上测量相应节段椎间隙前后柱高度、椎间隙夹角以及颈椎曲度(颈椎曲度采用Borden’s测量法和C_2-7Cobb角双线法);采用线性回归和多元线性回归分析上述各测量值之间的相关性,建立预测颈椎病患者颈脊髓受压程度的模型。结果:①各测量值随着颈脊髓受压加重而逐渐减小,椎间隙前高、椎间隙角度、a/M比值4组间两两比较差异均有统计学意义（P<0.05）。②a/M比值与椎间隙前高呈正相关（R=0.296,P<0.001）;a/M比值与弧弦距（颈椎曲度）呈正相关（R=0.241,P<0.001）;a/M比值与颈脊髓受压比例呈负相关（R=-0.821,P<0.001）;两种颈椎曲度测量法弧弦距与C_2-7Cobb角成正相关（R=0.840,P<0.001）。③经多元线性回归获得a/M比值的预测方程,其F=8.959,R=0.434,P<0.001,其中椎间隙前高、年龄和颈椎曲是颈脊髓受压的影响因素。结论:a/M比值可作为临床评价脊髓受压程度的标准;通过颈椎X线片的颈椎间隙、颈椎曲度的变化对颈脊髓受压程度的预测有一定的应用价值。     

Vertebral centroid measurement of lumbar lordosis compared with the Cobb technique.

STUDY DESIGN: An observational study in which vertebral centroid measurement of lumbar lordosis, developed in this study, was used to examine lumbar curvature. The intra- and interobserver reliability of the vertebral centroid measurement of lumbar lordosis and the Cobb technique were compared. OBJECTIVES: To evaluate the reliability of a new method of measuring lumbar lordosis and to examine the changes in the lordotic curve from 0 degree to 90 degrees flexion of the trunk. SUMMARY OF BACKGROUND DATA: Several different methods are used to measure lumbar lordosis. The Cobb technique, based on measurement of vertebral endplates, is the method most frequently adopted for clinical diagnosis. However, because of the variations in the vertebral endplate architecture, the vertebral surface angle is difficult to identify. This reduces the reliability of the Cobb technique. METHODS: Lateral radiographs of 16 study participants were taken from the upright position to a trunk flexion of 90 degrees in 30 degrees increments. The lumbar lordotic curve was measured by three observers individually using two applications of the traditional Cobb technique and the vertebral centroid measurement of lumbar lordosis. RESULTS: Correlation coefficients of lumbar lordosis between the two methods ranged from 0.589 to 0.772 with participants standing upright (all P < 0.05). Interobserver reliability coefficients were 0.903 for vertebral centroid measurement of lumbar lordosis, 0.826 for Cobb (L1-L5), and 0.784 for Cobb (L1-S1), although the three measurements all revealed an excellent intraobserver reproducibility (r greater than 0.9). The vertebral centroid measurement of lumbar lordosis showed the smallest mean absolute differences between any two observers' measurements (< 1.7 degrees). CONCLUSIONS: The findings from this study indicate that the vertebral centroid measurement of lumbar lordosis is more reliable than the Cobb method for assessing lumbar lordosis. The vertebral centroid measurement of lumbar lordosis also can be used to evaluate the actual lumbar curvature in outline at various angles of trunk flexion.     

Radiographic analysis of lumbar lordosis: centroid, Cobb, TRALL, and Harrison posterior tangent methods

STUDY DESIGN: Delayed, repeated measures, with three examiners each twice digitizing thirty lateral lumbar radiographs. OBJECTIVES: To determine the reliability and clinical utility of the centroid, Cobb, tangential radiologic assessment of lumbar lordosis (TRALL), and Harrison posterior tangent line-drawing methods for analysis of lumbar lordosis. BACKGROUND DATA: Cobb's method is commonly used for curvature analysis on lateral lumbar radiographs, whereas the centroid, TRALL, and Harrison posterior tangent methods are not widely used. METHODS: Thirty lateral lumbar radiographs were digitized twice by each of three examiners. To evaluate reliability of determining global and segmental alignment, all four vertebral body corners of T12-S1 and the superior margin of the femur head were digitized. Angles created were segmental and global centroid, (two-line) Cobb angles, and intersections of posterior tangents. A global TRALL angle was determined. Means, standard deviations, mean absolute differences, interclass and intraclass correlation coefficients (ICC), and confidence intervals were calculated. RESULTS: The interobserver and intraobserver reliabilities of measuring all segmental and global angles were in the high range (ICCs > 0.83). The mean absolute differences of observers' measurements were small (0.6 degrees -2.0 degrees ). Distal segmental (L4-S1) and global angles of lumbar curvature were dependent on the method of measurement. CONCLUSIONS: All four radiographic methods had high reliability and low mean absolute differences of observers' measurements. Because it lacks a segmental analysis, the TRALL method is not recommended. The centroid, Cobb, and Harrison posterior tangent methods provide global and segmental angles. However, the centroid segmental method requires three segments and is less useful for a stability analysis.     

Measurement of lumbar lordosis: inter-rater reliability, minimum detectable change and longitudinal variation

STUDY DESIGN: Repeated measures design to examine reliability and longitudinal variation of lumbar lordosis measurement. OBJECTIVES: To determine the interrater reliability, minimum detectable change (MDC) and longitudinal variation of the Cobb method for measuring lumbar lordosis using standardized rules. SUMMARY OF BACKGROUND DATA: The reliability of the 4-line Cobb method for measuring lumbar lordosis was not examined when standardized rules were instituted for drawing the lines. METHODS: A random sample of participants was selected from the Pittsburgh clinic of the multicenter Study of Osteoporotic Fractures for radiographic measurement of lumbar lordosis reliability (n=48) and stability (n=109). A standardized version of the 4-line Cobb method was used for all measurements of lordosis. The Intraclass Correlation Coefficient (ICC) was used to calculate interrater reliability for lordosis and to measure the stability of this measure over an approximate 2-year-time period. The standard error of measurement and MDC were calculated for lordosis measurement based on the ICC value. RESULTS: The interrater reliability coefficient for lumbar lordosis was in the excellent range (ICC=0.98; 95% CI: 0.95, 0.99). The MDC based on measurements between raters was 3.90 degrees. The ICC value for the stability, or reliability from time 1 to time 2, of lordosis measurement over time was 0.81 (95% CI: 0.74, 0.87). CONCLUSION: This study demonstrates that the 4-line Cobb method can be a highly reliable and precise method for measuring lumbar lordosis if standardized procedures are used. The Cobb method has an MDC that is appropriate for clinical use. Also, there is minimal longitudinal variation in lordosis measurements over a 2-year period.     

Range of motion and lordosis of the lumbar spine: reliability of measurement and normative values

STUDY DESIGN: Repeated measures for intratester reliability were performed. OBJECTIVES: To investigate the intratester reliability of a new measurement technique that evaluates lumbar range of motion in three planes using a pelvic restraint device, and to examine the reliability of lumbar lordosis measurement by inclinometer technique. Preliminary normative data on lumbar range of motion and lumbar lordosis were collected for comparison with the findings of previous studies. SUMMARY OF BACKGROUND DATA: Various noninvasive measurement methods have been developed for recording lumbar range of motion. However, pelvic movement was not effectively restricted during the use of these measurement techniques. The use of the pelvic restraint device to measure lumbar range of motion has not been investigated previously. Very few studies have investigated the reliability of quantifying lumbar lordosis by the inclinometer technique. METHODS: Normative values were measured in 35 healthy men, and 12 of these subjects were included for the reliability study. Pelvic motion was limited by the pelvic restraint device during lumbar range of motion measurement in standing. An inclinometer was used for evaluation of lumbar flexion, extension, lateral flexion, and lumbar lordosis, whereas a lumbar rotameter was used to measure axial rotation. RESULTS: Good intratester reliability was shown in the lumbar range of motion and lordosis measurement. Most of the intraclass correlation coefficient and Pearson's r values (accompanied with nonsignificant paired t tests) were greater than 0.9, and most of the intrasubject coefficients of variation were less than 10%. The values of lumbar range of motion in three planes and lumbar lordosis found in the current study were comparable with those from most of the previous studies on these measurements in the normal population. CONCLUSIONS: Inclinometer and lumbar rotameter measurements with the use of a pelvic restraint device are reliable for measuring lumbar spine range of motion. Use of the inclinometer technique to record lumbar lordosis also is a reliable measure.     

年轻颈痛患者颈椎弧度与颈椎间盘膨隆程度的相关性研究

目的:探讨颈椎弧度与年轻颈痛患者颈椎间盘膨隆程度的相关性。方法:回顾性分析2015年1月至2018年12月收治的539例年轻颈痛患者,其中男251例,女288例,年龄18~40(32.2±6.3)岁。通过颈椎X线和MRI检查测量患者的颈椎弧度和颈椎膨隆程度,并根据颈椎弧度将患者分为颈椎前凸组(颈椎弧度>7 mm)175例,颈椎直立组(0<颈椎弧度≤7 mm)163例和颈椎后凸组(颈椎弧度≤0 mm)201例。比较3组患者间颈椎间盘膨隆程度的差异,通过Pearson相关系数分析颈椎弧度与颈椎间盘膨隆程度的相关性。结果:颈椎前凸组、颈椎直立组、颈椎后凸组的颈椎间盘膨隆分别为(0.83±0.24)mm、(1.47±0.58)mm、(2.96±1.11)mm,颈椎前凸组的颈椎间盘膨隆程度小于颈椎直立组和颈椎后凸组(P<0.05)。Pearson相关性分析显示椎间盘膨隆程度与颈椎弧度呈显著负相关(R=-0.561,P<0.05)。结论:年轻颈痛患者的颈椎间盘膨隆程度与颈椎弧度减少密切相关。