人体全长X线片的构建及其评价整体矢状面平衡的可靠性和准确性

The establishment of full body splicing radiograph and study on its accuracy and reliability of global sagittal balance

中文关键词:  人体全长X线片  矢状面平衡  脊柱－骨盆－下肢矢状面参数  可靠性  准确性

英文关键词:Full-body splicing radiograph  Global sagittal balance  Pelvic sagittal parameters  Reproducibility of results

中文摘要:

  【摘要】 目的：应用数字化X线摄影（digital radiography，DR）系统构建新型人体全长X线片，并分析其评价人体整体矢状面平衡的可靠性和准确性。方法：2018年10月~2019年10 月，采用DR系统对30例志愿患者一次性连续曝光采集影像数据，运用医学图像处理软件全自动拼接获取人体全长X线片，其中男13例，女17例，年龄45～65岁（56.5±6.1岁）。同时接受全脊柱和下肢X线片检查。利用Surgimap软件由两名脊柱外科医师和一名影像科医师分别在人体矢状面全长X线片、全脊柱和下肢侧位X线片上分别独立测量：胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis， LL）、骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slop，SS）、矢状面垂直轴偏距（sagittal vertical axis，SVA）、骶股角（sacrofemoral angle，KFA）、膝关节角（knee angle，KA）、踝关节角（ankle angle，AA）、骨盆位移（pelvic shift，P.Shift）。通过独立样本t检验验证相关参数在不同摄片方式中的一致性，通过组内相关系数（ICC）分析观察者内以及观察者间参数值的一致性。结果：人体矢状面全长X线片与全脊柱和下肢侧位X线片上测量的脊柱-骨盆-下肢参数比较的P值为0.782～0.969，均无统计学差异，具有一致性。人体矢状面全长X线片测量的TK、LL、PI、PT、SS、SVA值与全脊柱侧位X线片上测量值的观察者内ICCs分别为0.696～0.857、0.724～0.873、0.672～0.943、0.691～0.851、0.648～0.852、0.645～0.867；观察者间的ICCs为0.678～0.822、0.704～0.872、0.772～0.904、0.763～0.936、0.665～0.824、0.541～0.665；人体矢状面全长X线片上测量的PI、PT、SS、KFA、KA、AA、P.shift值与下肢侧位X线片上测量值的观察者内ICCs分别为0.673～0.932、0.623～0.828、0.634～0.861、0.701～0.873、0.645～0.867、0.679～0.855、0.592～0.827；观察者间的ICCs为0.665～0.914、0.631～0.811、0.625～0.843、0.541～0.765、0.591～0.753、0.613～0.798、0.543～0.762。结论：采用DR系统一次性连续曝光成像构建人体全长X线片可行，脊柱-骨盆-下肢矢状面参数与全脊柱和下肢侧位X线片上测量结果一致率高，且具有良好的可靠性和准确性。

英文摘要:

  【Abstract】 Objectives: To construct a new full body splicing radiograph through digital radiography(DR) system, and to discuss the reliability and accuracy in its evaluation of overall sagittal balance. Methods: From October 2018 to October 2019, the DR system was applied to collect the image data of 30 volunteers at one time continuous exposure, and the medical image processing software was used to automatically stitch together and obtain clear and accurate full body splicing radiograph. There were 13 men and 17 women with an age of 45-65 years(mean age 56.5±6.1 years). The volunteers were also subjected to an examination of whole spine lateral radiographic and lateral scanogram of the normal DR radiography system. The parameters of thoracic kyphosis(TK), lumbar lordosis(LL), pelvic incidence(PI), pelvic tilt(PT), sacral slop(SS), sagittal vertical axis(SVA), sacrofemoral angle(KFA), knee flexion angle(KA), ankle angle(AA), and pelvic shift(P.shift) were measured. Two spine surgeons and an imaging physician performed imaging measurements by using Surgimap software at three different occasions. The correlation coefficients were validated by independent sample t-test. The consistency of parameter values within and between the observers was analyzed by the intragroup correlation coefficient(ICC). Results: The independent sample t-test of the full-body sagittal splicing radiograph and the whole spine radiograph and lower limbs extremity had no statistical difference(independent sample t-test, 0.782-0.969 P>0.05). The full-body sagittal splicing radiograph was compared to the whole-spine lateral radiograph, and the intraobserver ICCs of TK, LL, PI, PT, SS, SVA were 0.696-0.857, 0.724-0.873, 0.672-0.943, 0.691-0.851, 0.648-0.852, and 0.645-0.867, respectively. The interobserver correlation coefficients were 0.678-0.822, 0.704-0.872, 0.772-0.904, 0.763-0.936, 0.665-0.824, and 0.541-0.665. The full-body sagittal splicing radiograph was compared to the lateral scanogram, and the intraobserver ICCs of PI, PT, SS, KFA, KA, AA, and P.shift were 0.673-0.932, 0.623-0.828, 0.634-0.861, 0.701-0.873, 0.645-0.867, 0.679-0.855, and 0.592-0.827, respectively. The interobserver correlation coefficients were 0.665-0.914, 0.631-0.811, 0.625-0.843, 0.541-0.765, 0.591-0.753, 0.613-0.798, and 0.543-0.762. Intraobserver and interobserver reproducibility for both modalities were good to excellent. Conclusions: It is feasible to construct the full body splicing radiograph by digital radiography system. The sagittal parameters of the spine-pelvis-lower extremity measured by it are similar to the measurement results on the whole-spine lateral radiograph and the lateral scanogram, and have good reliability and repeatability.