以超音波影像引導觸診定位腰椎各節棘突位置

Locating Lumbar Spinous Process by Palpation with Sonographic Guidance

遲舒云(Shu-Yun Chih) ； 林亞蓉(Ya-Jung Lin) ； 王淑芬(Shwu-Fen Wang)

《物理治療》 33卷3期 (2008/06) Pp. 168-174

摘要

Background and Purpose: The accurate location of lumbar spinous processes is essential for clinical test or movement analysis of lumbar region. However, the reliability and validity for identifying lumbar levels via surface palpation were unacceptable in previous studies. Locating of anatomical structures with sonographic guidance has been shown excellent reliability and validity. The purpose of this study was to establish the methodology and to examine the accuracy and intra-day, inter-session test-retest reliability of locating lumbar spinous process by palpation with sonographic guidance. Methods: Twelve young and healthy subjects participated in this study. Marking location of echogenic hump of spinous process over the skin was identified through ultrasound. The distances of inter-spinous processes between L5 and other lumbar levels, and between the adjacent two lumbar levels were measured by ultrasonography. To assess the test-retest reliability, intra-class correlation coefficient (ICC), within-subject of coefficient of variance (CVw), standard error of measurement (SEM), and shift-error rate were calculated. Results: The shift-error rate, indicating the accuracy of this method, was 8.3% (2/24, n=12). Among the location without shift error (n=10), the intra-rater reliability (ICC: 0.80-0.92) and inter-rater reliability (ICC: 0.68-0.95) of the distance of inter-spinous process between L5 to other lumbar levels were fair to excellent (ICC=0.68-0.95). The intra-rater and inter-rater reliability of the inter-spinous process distance between the adjacent two lumbar levels was less satisfied (ICC=0.27-0.95). The CVw of all measures was within 10% except for the inter-spinous process distance between L4-5. Conclusions: We established the methodology of locating lumbar spinous process by palpation with sonographic guidance, with acceptatable shift-error and testretest reliability. Clinical relevance: The accurate location of lumbar spinous process is possible by the method of palpation with sonographic guidance.

關鍵字

超音波影像 ； 腰椎 ； 觸診 ； 信度

並列摘要

Background and Purpose: The accurate location of lumbar spinous processes is essential for clinical test or movement analysis of lumbar region. However, the reliability and validity for identifying lumbar levels via surface palpation were unacceptable in previous studies. Locating of anatomical structures with sonographic guidance has been shown excellent reliability and validity. The purpose of this study was to establish the methodology and to examine the accuracy and intra-day, inter-session test-retest reliability of locating lumbar spinous process by palpation with sonographic guidance. Methods: Twelve young and healthy subjects participated in this study. Marking location of echogenic hump of spinous process over the skin was identified through ultrasound. The distances of inter-spinous processes between L5 and other lumbar levels, and between the adjacent two lumbar levels were measured by ultrasonography. To assess the test-retest reliability, intra-class correlation coefficient (ICC), within-subject of coefficient of variance (CVw), standard error of measurement (SEM), and shift-error rate were calculated. Results: The shift-error rate, indicating the accuracy of this method, was 8.3% (2/24, n=12). Among the location without shift error (n=10), the intra-rater reliability (ICC: 0.80-0.92) and inter-rater reliability (ICC: 0.68-0.95) of the distance of inter-spinous process between L5 to other lumbar levels were fair to excellent (ICC=0.68-0.95). The intra-rater and inter-rater reliability of the inter-spinous process distance between the adjacent two lumbar levels was less satisfied (ICC=0.27-0.95). The CVw of all measures was within 10% except for the inter-spinous process distance between L4-5. Conclusions: We established the methodology of locating lumbar spinous process by palpation with sonographic guidance, with acceptatable shift-error and testretest reliability. Clinical relevance: The accurate location of lumbar spinous process is possible by the method of palpation with sonographic guidance.

並列關鍵字

Ultrasonography ； Lumbar spine ； Palpation