二维图像体表测量中三种角度指标评估非特异性颈痛患者姿势的信效度研究

Chinese Journal ofRehabilitation Medicine, Oct. 2019, Vol. 34, No.10?临床研老?二维图像体表测量中三种角度指标评估 非特异性颈痛患者姿势的信效度研究夏楠'张涛'王纯'郑倩’黄杰“摘要目的:探究二维图像体表测量中，三个头颈部姿势指标的评估者内及评估者间信度，对比分析和量化三者从姿势角 度对慢性非特异性颈痛的诊断及评估效能。方法:研究共招募52例慢性非特异性颈痛患者(CNNP)和23例正常人。使用整体姿态系统采集二维面图像后，进 行测量及相关研究分析。首先随机抽取25例CNNP患者图像数据分别由两个评估者在不同时间段对其颅椎角

(CVA)、矢状面头部仰角(SHA)和肩前伸角(PSA)进行测量，以探究评估者间及评估者内信度。随后由其中一位评

估者继续完成所有参与者的数据测量,汇总后进行诊断和评估效能研究。结果:CNNP患者SHA.CVA和PSA的评估者内/评估者间信度分别为0.859/0.790.0.846/0.809和0.91/0.917，评估者 内/间的三者的最小可检测变化(MDC)依次为3.536/4.234。2583/2.845。和7.429/7.147。。CNNP患者的SHA显著大

于正常人群(P<0.01),而CVA和PSA明显小于正常人群(P<0.01)o三者的受试者工作曲线下面积(AUC)依次分别 为0.861,0.794和0.947,PSA的效能最高。用于区分CNNP与正常人群的理想界值依次为19.5°、57.5。和31.5%

结论:二维图像测量CVA.SHA和PSA在评估CNNP患者的颈前伸、头后仰及圆肩的异常姿势中具有较好的信效 度。使用这些指标进行研究的过程中需要充分考虑其最小可检测差异和区分界值点。关键词 姿势;非特异性颈痛;信度;效度；图像测量中图分类号:R782,R493,R681.5

文献标识码：A 文章编号:1001-1242(2019)-10-1168-05Three indicators from two-dimensional body surface photographic measurements to assess the posture of patients with non-specific neck pain: a reliability and validity research/XIA Nan, ZHANG Tao, WANG

Chun,et al.//Chinese Journal of Rehabilitation Medicine, 2019, 34(10): 1168—1172AbstractObjective: To explore the intra? and inter-rater reliability of three head and neck posture indicators in photo?

graphic images to assess the posture of patients with chronic non-specific neck pain (CNNP), and to compare

and quantify the diagnosis and assessment of chronic non-specific neck pain from the perspective of posture.Method: A total of 52 patients with CNNP and 23 normal subjects were enrolled. After collecting the right side image of the participants using the Global Posture System, 25 patients were randomly selected and the Cra- niovetebral Angle (CVA), Sagittal Head Angle (SHA) and Portracted Shoulder Angle (PSA) were measured by

two assessors at two different time for reliability study. Then one of the assessors continued to complete the

measurements of all participants for validity study.Result： The intra? and inter-rater reliability of SHA, CVA, and PSA in CNNP patients were 0.859/0.790, 0.846/0.809, and 0.91/0.917, respectively. And the corresponding minimal detectable change were 3.536/4.234°, 2.583/2.845° and 7.429/7.147°. The SHA of patients with CNNP was significantly greater than that of the nor-DOI: 10.3969/j .issn. 1001 -1242.2019.10.0061华中科技大学同济医学院附属同济医院，湖北省武汉市斫口区解放大道1095号,430030； 2中山大学附属第一医院康复医学科；3通讯作者作者简介:夏楠，男，中级治疗师；收稿日期:2019-07-031168 wurw.rehabi. com.cn