Spurway Alan J, Hurry Jennifer K, Gauthier Luke, Orlik Ben, Chukwunyerenwa Chukwudi K, Kishta Waleed E, El-Hawary Ron
*Orthopaedics Department, IWK Health Centre †Department of Surgery ‡School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada.
J Pediatr Orthop. 2017 Dec;37(8):e631-e637. doi: 10.1097/BPO.0000000000001031.
Current assessment of spine growth for patients undergoing growth friendly surgical treatment for early-onset scoliosis (EOS) is the use of serial, 1-dimensional standard-of-care coronal vertical spine height (SoCVH) measurements. Any growth of the spine out of the coronal plane is missed by the SoCVH, which may underestimate the actual growth of the spine. This study set to validate the novel 3-dimensional true spine length (3DTSL) radiographic measurement technique for measuring growth of EOS patients.
3DTSL measurement accuracy, reliability, and repeatability was assessed using 10 physical model configurations. In addition, interrater and intrarater reliabilities (IRRs) were assessed using interclass coefficient (ICC) analyses of 23 retrospective EOS patient clinical radiographs. 3DTSL measurements were compared with SoCVH measurements.
The model assessment showed excellent accuracy with a mean error of 1.2 mm (SD=0.9; range, 0.0 to 3.0) and mean ICC of 0.999.IRR ICCs of the clinical radiographs averaged 0.952 for the 3DTSL and 0.975 for the vertical height whereas IRRs averaged 0.944 and 0.965, respectively (all P<0.001).Mean clinical 3DTSL curve lengths were 193.9 mm (SD=30.0; range, 142.8 to 276.8), whereas the SoCVH averaged 156.1 mm (SD=29.7; range, 74.7 to 207.3). The mean difference between the matched 3DTSL and SoCVH measurements was 37.8 mm (SD=21.4; range, 1.3 to 95.4) and was statistically significant (P<0.0001). On average, the 3DTSL of the measured spines was 124.2% of the measured SoCVH, with a progressive difference as the Cobb or kyphosis angles increased.
The novel 3DTSL measurement is accurate, repeatable, and complements the current growth assessments for EOS treatments.
Level II-diagnostic study-development of a diagnostic criteria on basis of consecutive patients, with gold standard.
目前对于接受早期特发性脊柱侧凸（EOS）生长友好型手术治疗患者的脊柱生长评估，是采用一系列一维标准护理冠状位垂直脊柱高度（SoCVH）测量。SoCVH会遗漏脊柱在冠状面外的任何生长情况，这可能会低估脊柱的实际生长。本研究旨在验证用于测量EOS患者生长情况的新型三维真实脊柱长度（3DTSL）放射学测量技术。
使用10种物理模型配置评估3DTSL测量的准确性、可靠性和可重复性。此外，通过对23例回顾性EOS患者临床X光片进行组内相关系数（ICC）分析，评估评分者间和评分者内的可靠性（IRR）。将3DTSL测量结果与SoCVH测量结果进行比较。
模型评估显示准确性极佳，平均误差为1.2毫米（标准差=0.9；范围为0.0至3.0），平均ICC为0.999。临床X光片的IRR ICC中，3DTSL平均为0.952，垂直高度平均为0.975，而IRR分别平均为0.944和0.965（所有P<0.001）。临床3DTSL曲线平均长度为193.9毫米（标准差=30.0；范围为142.8至276.8），而SoCVH平均为156.1毫米（标准差=29.7；范围为74.7至207.3）。匹配的3DTSL和SoCVH测量之间的平均差异为37.8毫米（标准差=21.4；范围为1.3至95.4），具有统计学意义（P<0.0001）。平均而言，测量脊柱的3DTSL是测量的SoCVH的124.2%，随着Cobb角或后凸角增加差异逐渐增大。
新型3DTSL测量准确、可重复，补充了目前EOS治疗的生长评估。
II级——诊断性研究——基于连续患者并采用金标准制定诊断标准。
