定位頸椎臨床研究－以觸診及超音波測量頸椎棘突間距離之信度

背景與目的：觸診(pa1pation)對物理治療師而言是一個基本且重要的評估技巧。觸診的目的在確實去定位引起病人症狀之脊椎位置或附近之軟組織異常。本研究之前驅試驗欲探討同一施測者單獨使用觸診、單獨使用超音波的再測信度及不同施測者間的信度。主要實驗部分在探討以超音波影像協助觸診定位頸椎棘突位置之同一日的施測者內再測信度及不同日的測試者內再測信度。方法：以方便取樣的方式徵召年齡在20-40歲之間的十四男性、十名女性受試者平均年齡27.5±4.6歲，分別參與前驅試驗與主要實驗，測試方式為定位頸椎第二到第七節棘突位置，並測量相鄰棘突之距離。以無母數統計中威爾科克森配對符號排序檢定(Wilcoxon Sign Rank Test)分析測量信度（前驅試驗），計算相鄰棘突距離之再測信度，並計算受試者內之變異係數(CVw，within subject coefficient of variation)。結果：頸椎相鄰節間距離為12.8±2.4-20.0±3.2mm。施測者內信度顯示於測量相鄰節間距離無統計差異。於單獨使用觸診測量C4-5、C6-7節及單獨使用超音波時測量C5-6節間距離之變異係數大於10%。施測者間信度顯示於單獨使用超音波測量C3-4節間距離有統計差異。其餘情況則無差異。於單獨使用觸診測量及單獨使用超音波測量節間距離之變異係數均大於或趨近於10%。主要實驗顯示超音波影像輔助觸診定位頸椎同日之再測信度，變異係數6%-10%，為可接受之範圍。然而不同日之再測信度之變異係數略大，在6%-12%之範圍。結論：由本實驗的結果來看，合併觸診與超音波，測量相鄰棘突距離之結果，同日內之測量信度好，不同日之測量信度仍有待改進。臨床意義：臨床上將觸診與超音波兩者結合，對骨骼肌肉系統問題的評估與診斷有助益。

關鍵字

頸椎；觸診；超音波；信度

並列摘要

Background and Purpose: Spinous process palpation is a basic and important skill for physical therapists. The purpose of the pilot study was to investigate the intrarater and interrater reliability of locating cervical spinal levels by palpation and ultrasonography. The purpose of the main study was to investigate the intra-rater reliability of locating cervical spinal levels by palpation and ultrasonography on different testing sessions and days. Methods: Fourteen men and ten women (mean age 27.5±4.6 y/o) without history of deformities of cervical spine and cervical surgery were included in the study. The subjects were asked to locate cervical spine level and then to measure the distances between markers. Data were analysed by Wilcoxon Sign Rank Test. The within subject coefficient of variation (CVw) was also used to assess the variability of locating the spinal levels. Results: The average interspinal distance ranged from 12.8±2.4 to 20.0±3.2mm. There is no significant difference between the same levels of two tests by the same tester. The CVw values of C4-5 and C6-7 interspinal distance (palpation) and C5-6 (ultrasonography) were greater than 10%. The inter-session reliability of ultrasonography guided palpation was satisfied. The coefficients of variation were under 10.7%. The intra-rater reliability in different days was not satisfied and the ranges of coefficients of variation were from 6% to 12%. Conclusion: The intra-rater reliability of ultrasonography guided palpation on the same day was better than tested at different days. The ultrasonography guided palpation improves the accuracy of identifying the different spinal levels.

並列關鍵字

Cervical spine ； Palaption ； Ultrasonography ； Reliability

國際替代計量

定位頸椎臨床研究－以觸診及超音波測量頸椎棘突間距離之信度

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