Sullivan T Barrett, Bastrom Tracey, Reighard Fredrick, Jeffords Megan, Newton Peter O
Department of Orthopedics, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA.
Department of Orthopedics, Rady Children's Hospital, San Diego, 3020 Children's Way, San Diego, CA 92123, USA.
Spine Deform. 2017 Jul;5(4):244-249. doi: 10.1016/j.jspd.2017.01.012.
Retrospective cohort analysis.
To use a large cohort of three-dimensional (3D) spinal reconstructions to create a simple mathematical formula capable of estimating 3D apical vertebral rotation (AVR) based on the correlation with routinely obtained two-dimensional (2D) measurements of scoliosis.
Quantification of vertebral rotation in AIS using 2-dimensional (2D) imaging is inherently challenging as the axial plane cannot be directly visualized.
A database of 279 3D spinal reconstructions was queried for patients with thoracic major adolescent idiopathic scoliosis (AIS). 2D thoracic Cobb angle, T5-T12 thoracic kyphosis, pelvic incidence, sacral slope, and pelvic tilt were recorded. 3D AVR was calculated for each patient from 3D reconstructions. Patients were divided into development (n = 186) and validation (n = 93) cohorts. Within the development cohort, univariate analysis was performed between 2D measurements and 3D AVR with significance set at p < .05 for inclusion in multivariate analysis. In multivariate analysis, significance was set at p < .01 for inclusion in the final model. Model performance was tested in development and validation cohorts.
Only 2D thoracic Cobb and T5-T12 thoracic kyphosis had significance in univariate (p < .05) and multivariate analyses (p < .01), meriting inclusion in the final model. 3D AVR (°) = 0.26*(T5-T12 kyphosis) + 0.34*(coronal Cobb) - 5.38. In the development cohort, the model performed well (R = 0.739, r = 0.54). In testing with the validation cohort, the model proved generalizability (R = 0.703) and had a mean absolute error <5°.
This model is capable of estimating 3D AVR given 2D thoracic Cobb and T5-T12 kyphosis. The accuracy of this method is comparable to previously reported methods of 2D axial rotation measurement. However, this model provides 3D axial rotation and requires no physical instruments, non-standard measurements, or software programs. Such a model is valuable for both routine evaluation of AIS and operative preparation.
Level II, diagnostic.
回顾性队列分析。
利用大量三维（3D）脊柱重建数据创建一个简单的数学公式，基于与脊柱侧弯常规获取的二维（2D）测量值的相关性来估计三维顶椎旋转（AVR）。
由于无法直接观察轴向平面，使用二维（2D）成像对特发性脊柱侧弯（AIS）中的椎体旋转进行量化具有内在挑战性。
查询了一个包含279例三维脊柱重建数据的数据库，以获取患有胸段为主的青少年特发性脊柱侧弯（AIS）的患者。记录二维胸段Cobb角、T5 - T12胸段后凸、骨盆入射角、骶骨倾斜度和骨盆倾斜度。通过三维重建为每位患者计算三维AVR。患者被分为开发队列（n = 186）和验证队列（n = 93）。在开发队列中，对二维测量值和三维AVR进行单变量分析，纳入多变量分析的显著性设定为p < 0.05。在多变量分析中，纳入最终模型的显著性设定为p < 0.01。在开发队列和验证队列中测试模型性能。
仅二维胸段Cobb角和T5 - T12胸段后凸在单变量（p < 0.05）和多变量分析（p < 0.01）中有显著性，值得纳入最终模型。三维AVR（°）= 0.26×（T５ - T12后凸）+ 0.34×（冠状面Cobb角） - 5.38。在开发队列中，模型表现良好（R = 0.739，r = 0.54）。在验证队列测试中，该模型证明具有可推广性（R = 0.703），且平均绝对误差<5°。
该模型能够根据二维胸段Cobb角和T5 - T12后凸估计三维AVR。该方法的准确性与先前报道的二维轴向旋转测量方法相当。然而，该模型提供三维轴向旋转，且不需要物理仪器、非标准测量或软件程序。这样的模型对于AIS的常规评估和手术准备都很有价值。
二级，诊断性。
