3D打印颈椎枕的压力疼痛评估及信度分析

关键词：压痛阈值  测痛仪  信度  3D打印颈椎枕

Keywords:pressure pain threshold  pain meter  reliability  3D printed cervical pillow

摘要：

      摘要 目的：通过信度分析压痛测量仪评估颈肩部压痛的可靠性，并为3D打印个性化颈椎枕的临床效果评估提供新方式。 方法：选取健康受试者36例，分别由2位评估者使用压痛测量仪对其颈肩部肌肉的7个测量点进行2次压痛阈测量，间隔7天后再次测量，采用Spearson相关系数计算评估者内和评估者间的信度，并使用Mann-Whitney U检验比较男性与女性的压痛阈值（pressure pain thresholds， PPT）。个性化颈椎枕使用前后，使用压痛测量仪对13例颈椎病患者选取具有代表性的4个测量点进行PPT测量，用以评估3D打印颈椎枕的治疗效果。 结果：除了受测点C5、C6的棘突间旁1cm右侧和肩胛上角左侧外，各受测点评估者内信度均>0.65，各受测点评估者间信度均>0.75，可信度高；C5、C6的棘突间旁1cm右侧和肩胛上角左侧的评估者内组内相关系数（intraclass correlation coefficient，ICC）分别为0.65和0.56，中等信度（P<0.01）；健康男性的斜方肌右侧、肩胛上角R、C5、C6的棘突间旁1cm左侧平均值要大于女性（P<0.05）；斜方肌右侧、C5、C6的棘突间旁1cm右侧和C5、6的棘突间旁1cm左侧受测点3D打印颈椎枕治疗后的PPT平均值比治疗前大，差异具有显著性意义（P<0.05），说明疼痛有改善。 结论：压痛测量仪评估正常健康人颈部压痛阈值信度较高，该方法稳定可靠，可作为3D打印颈椎枕临床效果评估的有效工具。

Abstract:

      Abstract Objective： To evaluate the reliability of neck and shoulder pressure pain assessment by reliability analysis of a pressure pain measurement instrument and develop a new way to assess the clinical effectiveness of 3D printed personalized cervical pillows. Method： Thirty-six healthy subjects were selected， and two assessors used a pressure pain meter to measure the pressure pain threshold twice on 7 points of the neck and shoulder muscles of the healthy subjects. The measurements were repeated after a 7-day break. The intra- and inter-assessor reliability was determined by the Spearson correlation coefficient, and the Mann-Whitney U test was used to evaluate the pressure pain thresholds (PPT) compared between males and females. Before and after the use of the personalized cervical pillow， PPT was measured using a pressure pain meter at four representative measurement points for 13 patients with cervical spondylosis to assess the therapeutic effect of the 3D printed cervical pillow. Result： The intra-assessor reliability was ＞ 0.65 for each subject point except for 1cm away from the right interspinous paraspinal of C5 and C6 and the left suprascapular angle, and the inter-assessor reliability was ＞ 0.75 for each subject point with high reliability. The intra-assessor intraclass correlation coefficient (ICC) values for the 1cm away from the right interspinous paraspinal of C5 and C6 and the left suprascapular angle were 0.65 and 0.56， respectively， with moderate reliability（P<0.01）. The healthy males had greater mean values on the right trapezius，right suprascapular angle， and 1cm away from the left interspinous paraspinal of C5 and C6 than women（P<0.05）； the mean values of PPT after treatment with 3D-printed cervical pillows on the right oblique，1cm away from the right interspinous paraspinal of C5 and C6， and 1 cm away from left interspinous paraspinal of C5 and C6 were greater than before treatment，with statistically significant differences（P<0.05）， indicating the improvement in pain. Conclusion： A valid tool for evaluating the clinical effects of 3D printed cervical pillows can be used to measure the pressure pain threshold of the neck in normal healthy individuals by applying a pressure pain measurement instrument. The method is stable and reliable.