雖然攝影動作分析系統相對於放射線X光具有動態和沒有輻射的優勢，但是過去的文獻中並未有運用此系統分析測量頸椎局部動作之研究。 本研究之目的是要建立一個頸部表面標識的定位方法，以區別上、下頸椎之局部動作和量測姿態; 另外並運用螢光透視攝影，檢測利用頸部表面標識來測量頸椎局部動作之可行性。 十六位健康成年人(8位男性和8位女性)參與本研究。 十個表面標識被使用來估計與對應頸椎解剖標記於動作範圍之差異。 在頸部活動的同時，由表面標識和解剖標記所構成之對應的頸椎角度，其組間相關係數介於0.844和0.975之間而平均絕對誤差值為2.97度。 本研究之結果顯示由表面標識和解剖標記所構成之對應的頸椎角度於頸部彎曲伸展時有很高的一致性。 在正中姿勢下量得之上、下頸椎角度分別為18.59 ± 4.33 度以及 23.98 ± 6.15度。 此外量測人員本身數位化頸椎角度過程的可信度為組間相關係數0.850-0.999;平均絕對誤差值為0.58–2.42度。 量測人員之間數位化頸椎角度過程的可信度為組間相關係數0.759-0.988;平均絕對誤差值為0.59–2.66度。 本研究之結果支持透過使用此頸部表面標識的定位方式，可以提早偵測出上、下頸椎姿勢形態或者運動時椎間角度變化之可行性。 另一方面，對於頸椎彎曲、伸展動作時產生之椎體間移動研究的缺乏，造成無法更為深入地瞭解頸椎生物力學及治療頸部機能障礙。 本研究第四章之目的在於運用螢光透視攝影技術，分析頸椎彎曲、伸展動作時產生之連續椎體間角度變化及移動。 四十八位健康成年人的頸椎彎曲與伸展時之連續動作影像以精確的影像模式來分析。 本章之研究結果顯示頸椎彎曲、伸展動作時頸椎C2/3到C6/7的角度分別為13.08，17.54，22.37，19.16以及16.58度。 C4/5，C5/6以及C6/7節於頸椎彎曲動作時有明顯較大的角度貢獻; 而C4/5節於頸椎伸展動作時有明顯較大的角度貢獻(P<0.001)。 頸椎彎曲動作時椎體間移動之程度依序分別為C2/3節(0.7公釐)，C6/7節(0.9公釐)，C3/4節(1.0公釐)， C5/6節(1.1公釐)以及C4/5節(1.2公釐)。 而C3/4，C4/5和C5/6節椎體間往後移動之程度明顯大於往前移動之程度(P = 0.041，P = 0.045，P = 0.006)。 C6/7節呈現出起伏及最少之椎體間往後移動(0.4公釐)顯示受測者間頸椎伸展動作時的變異性。 將椎體間移動程度以個別椎體寬度標準化後，其C2/3到C6/7的移動百分比分別為9.3%，14.0%，16.7%，15.3%以及8.7%。 此結果是為臨床上椎體間移動的正常範圍。 藉此，運用已驗證之放射線影像模式，頸椎體間於彎曲與伸展時之椎體間移動將首次呈現其質與量。 此分析方式可能可以應用於診斷不正常頸椎間移動之病理問題，例如活動度過低或過高;以及偵測治療頸部機能障礙之效果。

Despite offering dynamic assessment without radiation, the video-based motion analysis system has not yet been applied to measure the cervical segmental movements. The purposes of this thesis were to develop a method of positioning the surface markers to differentiate the movements and posture between upper and lower cervical spine, and to examine the reliability of measuring cervical motion with surface markers with the aid of videofluoroscopy. Sixteen healthy adult subjects (eight males and eight females) participated in this study. Ten surface markers were used to estimate the discrepancies in cervical vertebral angles compared with corresponding anatomic landmarks throughout the ROM. The average intraclass correlation coefficients (ICCs) of the paired vertebral angles between surface markers and anatomic landmarks ranged from 0.844 to 0.975 and the mean absolute difference (MAD) averaged 2.97°. Our results indicate high consistency between surface markers and anatomic landmarks throughout the cervical movements. The mean upper (C0–C2) and lower (C2–C7) cervical joint angles in the neutral position were 18.59° ± 4.33° and 23.98° ± 6.15°, respectively. Furthermore, the reliability of the digitizing procedure within raters (ICC = 0.850–0.999; MAD = 0.58–2.42°) and between raters (ICC = 0.759–0.988; MAD = 0.59–2.66°) suggests that our positioning of the surface markers is a feasible method for investigating static neck posture or dynamic motion between upper and lower cervical spine. On the other hand, the insufficient exploration of intervertebral translation during flexion and extension prevents the further understanding the cervical biomechanics and treating the cervical related dysfunction. The objective of chapter four was to quantitatively measure the continuous intervertebral angulation and translation of healthy cervical spine during flexion and extension by videofluoroscopic technique. The image sequences were analyzed for 48 healthy adult subjects by a precise image protocol during cervical flexion and extension. The results of the total angular motion were 13.08°, 17.54°, 22.37°, 19.16°, and 16.58° for C2/3 to C6/7 levels, respectively. The C4/5, C5/6, and C6/7 segmental levels significantly contributed more angular motion during the cervical flexion; whereas the C4/5 segment contributed the greatest motion during the cervical extension (P<0.001). Our results showed that during cervical flexion the smallest anterior translations were 0.7mm at C2/3 level, followed by 0.9mm at C6/7, 1.0mm at C3/4, 1.1mm at C5/6, and 1.2mm at C4/5, respectively. The significantly greater translations were measured in the posterior direction than in the anterior one at C3/4 (P = 0.041), C4/5 (P = 0.045), and C5/6 levels (P = 0.006). The relatively fluctuant translation fashion and the least posterior translation (0.4mm) at C6/7 level implied a larger variation in cervical extension pattern among subjects. Normalization with respect to the widths of individual vertebrae showed the total translation percentages relative to the adjacent vertebrae were 9.3%, 14.0%, 16.7%, 15.3%, and 8.7% for C2/3 to C6/7 levels, respectively, and appeared to be within the clinical-accepted ranges of translation in cervical spine. The intervertebral translations of cervical spine during flexion and extension movements were first described in quality and quantity based on the validated radiographic protocol. This analysis of the continuous intervertebral translations may be further employed to diagnose translation abnormalities like hypomobility or hypermobility and to monitor the treatment effect on cervical spines.

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