柯伯角度、軀幹旋轉角度和三維胸椎和腰椎姿勢位置與活動度之再測信度

Test-Retest Reliability of the Cobb Angle, Angle of Axial Trunk Rotation, and 3D Ultrasound Measurements of the Thoracic and Lumbar Spine

丁于旻(Yu-Min Ding) ； 林千禾(Janice Chien-Ho Lin) ； 張晢鏞(Cheh-Yung Chang) ； 王子娟(Wendy TJ Wang)

《物理治療》 40卷4期 (2015/12) Pp. 157-166

https://doi.org/10.6215/FJPT.PTS1431332648

摘要

背景與目的：脊椎病患之軀幹姿勢與活動度是臨床與研究重要的評估項目，使用精確的測量工具十分重要，而良好的信度與效度是測量工具不可或缺的特質。本研究之目的在於分析同一施測者測量脊柱側彎患者X光影像之柯伯角度和軀幹旋轉角度之再測信度，以及兩者之相關性，並以Zebris三維超音波動作分析系統測量正常成年人之胸椎和腰椎姿勢以及胸椎和腰椎活動度之再測信度。方法：由一位施測者針對20名男性和女性脊柱側彎患者（平均年齡為23.95±6.81歲）之X光柯伯角度和軀幹旋轉角度進行量測。另外，以Zebris三維超音波動作分析測量儀量測10名健康受試者（平均年齡：23.98±1.26歲）之胸椎和腰椎的姿勢以及脊椎活動度。除了X光測量外，軀幹旋轉角度以及所有的脊椎姿勢與活動度測量均進行同日內重覆測量以及不同日之再次測量。各項測量的同日與不同日再測信度均是以級內相關係數（intraclass correlation coefficient, ICC）來計算分析，並利用皮爾森相關係數（Pearson's correlation coefficient）分析胸腰椎柯伯角度和軀幹旋轉角度之相關。結果：同一施測者在同日內與不同日測量之再測信度達高度以上，包含柯伯角度（ICC=0.912、0.995）、軀幹旋轉角度（ICC=0.954、0.952）、胸椎後凸角度（ICC=0.868、0.843）、腰椎前凸角度（ICC=0.886、0.837）、矢狀面脊椎弧度（ICC=0.941、0.912）、肩膀相對骨盆相對傾斜角度（ICC=0.875）、兩側骨盆高低差距（ICC=0.883、0.792）、兩側肩膀高低差距（ICC=0.827）、胸椎和腰椎前彎活動度（ICCs=0.778~0.921）、胸椎後仰活動度（ICC=0.791、0.781）以及胸椎側彎活動度（ICCs=0.722~0.868）。但是，骨盆扭轉角度、肩胛骨兩側距離中線之差距、腰椎後仰及側彎活動度的同日再測信度較低（ICCs=0.175~0.359）。骨盆傾斜角度、肩膀和骨盆相對傾斜角度、肩膀兩側高低差距以及肩胛骨兩側距離中線之差距的不同日再測信度為低度至中度（ICCs=0.319~0.667）。腰椎後仰與側彎活動度之不同日再測信度也較低（ICCs=0.201~0.468）。而軀幹旋轉角度與柯伯角度之間為中高度相關（r=0.73）。討論與結論：以X光量測脊柱側彎患者之柯伯角度以及以軀幹旋轉水平測量儀量測軀幹旋轉角度之方法不論同一天或不同天之測量，一致性相當高。使用Zebris三維超音波動作分析系統針對胸腰椎姿勢之測量，大部份測量參數呈現高度的再測信度，對於測量信度較低的參數，測試方式或測試中解說的修正可能有助改善測試信度，但需要更多研究予以探討。這些測試方法的效度也需要未來研究予以驗證。

關鍵字

柯伯角度 ； 軀幹旋轉角度 ； 三維超音波動作分析 ； 脊椎姿勢位置 ； 再測信度

並列摘要

Background and Purpose: Mobility and dynamic control of spine has been the subject of much clinical discussion recently. Surveying instruments for the posture and mobility of spine are widely used in spinal assessment or exercise intervention related research. The purpose of the study was to explore within-day and between-days intra-rater reliability of Cobb angle, angle of axial trunk rotation, and 3D-ultrasound analysis system with pointer application in assessing mobility and posture of the thoracolumbar spine and bone landmarks. Methods: Twenty subjects with scoliosis (mean age: 23.95±6.81 years) were recruited for the reliability test of the X-ray Cobb angle and the angle of axial trunk rotation. Ten healthy adults (mean age: 23.98±1.26 years) were recruited for the reliability test of the posture parameters and the mobility of thoracolumbar spine. 3D ultrasound motion analysis system measurements were taken in natural standing position, maximum spinal extension, maximum spinal flexion and bilateral side flexion in standing position. Intraclass correlation coefficients (ICCs) and standard errors of measurements were used for statistical analyses. Pearson's correlation coefficient was used to determine the correlation between X-ray Cobb angle and the angle of axial trunk rotation. Results: The results showed that within-day and between-day intra-rater reliabilities of measuring the Cobb angle and the axial trunk rotation are good (ICCs=0.912~0.995). The 3D-ultrasound motion analysis system also provided good within-day and between-day intra-rater reliabilities in assessing thoracic kyphosis (ICC=0.868, 0.843), lumbar lordosis (ICC=0.886, 0.837), sagittal spinal curve (ICC=0.941, 0.912), pelvic and shoulder obliquity (ICC=0.875), pelvic height difference (ICC=0.883, 0.792), shoulder height difference (ICC=0.827), and the mobility of thoracic/lumbar flexion (ICC=0.778~0.921), thoracic extension (ICC=0.791, 0.781), thoracic side flexion (ICCs=0.722~0.868). However, the within-day reliabilities of measuring pelvic torsion, scapula distance difference, mobility of the lumbar extension and side flexion were low (ICCs=0.175~0.359). Between-day reliabilities of measuring pelvic inclination, pelvic/shoulder obliquity, shoulder height difference right/left, scapula distance difference and the mobility of the lumbar extension and side flexion were also low to moderate (ICCs=0.201~0.667). The correlation between the X-ray Cobb angle and the angle of axial trunk rotation was moderately high (Pearson r=0.73). Conclusion: The X-ray Cobb angle measurement, angle of axial trunk rotation, and most of the Zebris 3D-ultrasound analysis system measurement of the thoracolumbar spine posture showed good to high test-retest reliability. To further investigate the clinometric properties of these tests, more studies are needed to evaluate their validity.

並列關鍵字

Cobb angle ； Axial trunk rotation ； 3D ultrasound motion analysis system ； Spinal posture ； Intra-rater reliability