Which Lateral Radiographic Positioning Technique Provides the Most Reliable and Functional Representation of a Patient's Sagittal Balance?
Which Lateral Radiographic Positioning Technique Provides the Most Reliable and Functional Representation of a Patient's Sagittal Balance?
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DOI：
10.1097/brs.0b013e318199650a
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发表时间：
2009-04-20
期刊：
影响因子：
3
通讯作者：
Newton, Peter
中科院分区：
文献类型：
--
作者：
Marks, Michelle;Stanford, Chriss;Newton, Peter
研究设计.前瞻性非脊柱侧凸队列研究评价不同体位对获得站立位侧位胸腰椎X线片的影响。本研究的目的是比较不同上肢体位对胸腰椎矢状位脊柱排列的影响。用于拍摄侧位X线片的站立位可能对矢状面脊柱排列的测量结果有显著影响，并可能使连续X线片测量结果之间的变异性复杂化。22名健康女性青少年在运动分析实验室中进行了3次4种站立姿势的重复试验。这些职位包括：（1）放松站立，双臂置于两侧（对照组），（2）站立时拳头覆盖同侧锁骨（锁骨），（3）主动肩关节屈曲至30，肘部伸展（30主动）和（4）被动肩关节屈曲至30，手支撑（30例被动）。脊柱的矢状面对准通过脊柱后凸、脊柱前凸和矢状面垂直轴（SVA）来描述，所有这些都是从附着在背部和骨盆表面上的反射标记的位置测量的。计算了3个X线摄影位置中每一个相对于功能位置（对照）获得的对线测量值之间的差异。然后使用重复测量ANOVA（α = 0.05）比较位置之间的平均差异。相对于对照位置，所有其他位置均导致SVA负移（范围= -1.1 cm - -4.6 cm）、脊柱后凸减少（范围= -1 °--3 °）和脊柱前凸增加（所有位置均为4）。30 °被动体位的SVA变化显著小于其他2个体位（P < 0.05），且变异性最小。在用于侧向脊柱骨盆放射摄影采集的定位期间，在弯曲肩部30的同时支撑着手站立，导致SVA和矢状面曲率的测量结果与手臂在侧面的功能性站立位置相当。这似乎是最好的方式来移动手臂前方的脊柱与最小的影响，对整体矢状面的平衡。
Study Design. Prospective nonscoliotic cohort evaluation of the effects of various positions for obtaining standing lateral thoracolumbar radiographs.Objective. The purpose of this study was to compare the effects of various upper extremity positions on thoracolumbar sagittal spinal alignment.Summary of Background Data. The standing position used to capture a lateral plane radiograph can have marked effects on measurements of sagittal spinal alignment and may compound the variability between measurements from successive radiographs.Methods. Twenty-two healthy female adolescents performed 3 repeated trials of 4 standing positions in a motion analysis laboratory. The positions included: (1) relaxed standing with arms at sides (CONTROL), (2) standing with fists overlying ipsilateral clavicles (CLAVICLE), (3) active shoulder flexion to 30 with elbows extended (30 ACTIVE), and (4) passive shoulder flexion to 30 with hand supports (30 PASSIVE).Sagittal alignment of the spine was described by kyphosis, lordosis, and the sagittal vertical axis (SVA), all of which were measured from the positions of reflective markers attached to the surface of the back and pelvis. Differences between alignment measures obtained for each of the 3 radiographic positions relative to the functional position (CONTROL) were calculated. Mean differences were then compared between positions using repeated measures ANOVAs (alpha = 0.05).Results. Relative to the CONTROL position, all other positions resulted in negative shifts in SVA (range = -1.1 cm - -4.6 cm), decreased kyphosis (range = -1 degrees--3 degrees), and increased lordosis (4 for all positions). The shift in the SVA with the 30 PASSIVE position was significantly less than the other 2 positions (P < 0.05) and demonstrated the least variability.Discussion. Standing with the hands supported while flexing the shoulders 30 during positioning for lateral spinopelvic radiographic acquisition resulted in an SVA and measures of sagittal plane curvature that were comparable with a functional standing position with arms at the side. This seems to be the best way to move the arms anterior to the spine with the least effect on overall sagittal balance.