Negrini Stefano, Di Felice Francesca, Negrini Francesco, Rebagliati Giulia, Zaina Fabio, Donzelli Sabrina
Department of Biomedica, Surgical and Dental Scientes, University "La statale", Milan, Italy.
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Eur Spine J. 2022 Dec;31(12):3519-3526. doi: 10.1007/s00586-022-07165-3. Epub 2022 Apr 4.
In-brace radiograph of adolescents with idiopathic scoliosis (AIS) has been shown to reflect brace efficacy and the possibility of achieving curve correction. Conversely, the first out-of-brace radiograph could demonstrate the patient's ability to maintain the correction. We aimed to determine which of the two radiographs is the best predictor of the Cobb angle at the end of treatment (final radiograph).
Retrospective cohort study of a prospective dataset.
The population was selected based on the following inclusion criteria: AIS, age 10-18 years; Risser score 0-2; Cobb angle 25-40°; brace treatment; availability of all radiographs.
Pearson correlations provide a first exploration of data. The univariate and multivariate logistic regression model tested the predictors. Finally ROC curve provided a check of model accuracy.
A total of 131 patients were included (mean age 13.0 ± 1.3, Cobb angle 33.2 ± 5.5°; 78% females). At the end of treatment, 56% had stabilised, 9% had progressed, and 44% had improved. The difference between the in-brace and final radiographs was 8.0 ± 6.0°, while the difference between the first out-of-brace and final radiographs was 1.8 ± 5.2°. The best predictor of final outcome was the first out-of-brace radiograph (0.80), compared to in-brace (0.68) and baseline (0.59) radiographs. The best cut-offs to predict avoidance of progression were 30% and 10% of the correction rates for the in-brace and first out-of-brace radiographs, respectively.
The first out-of-brace radiograph predicts end results better than the in-brace radiograph. It offers an excellent clinical reference for clinicians and patients. The first out-of-brace radiograph should be considered an essential element of future predictive models. LEVEL OF EVIDENCE 1: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
特发性脊柱侧凸（AIS）青少年的支具内X线片已被证明可反映支具疗效及实现曲线矫正的可能性。相反，首次支具外X线片可显示患者维持矫正的能力。我们旨在确定这两种X线片中哪一种是治疗结束时（最终X线片）Cobb角的最佳预测指标。
对前瞻性数据集的回顾性队列研究。
根据以下纳入标准选择研究对象：AIS，年龄10 - 18岁；Risser评分0 - 2；Cobb角25 - 40°；接受支具治疗；有所有X线片。
Pearson相关性分析对数据进行初步探索。单变量和多变量逻辑回归模型检验预测指标。最后，ROC曲线检验模型准确性。
共纳入131例患者（平均年龄13.0 ± 1.3岁，Cobb角33.2 ± 5.5°；78%为女性）。治疗结束时，56%病情稳定，9%病情进展，44%病情改善。支具内与最终X线片的差值为8.0 ± 6.0°，而首次支具外与最终X线片的差值为1.8 ± 5.2°。与支具内（0.68）和基线（0.59）X线片相比，最终结果的最佳预测指标是首次支具外X线片（0.80）。预测避免病情进展的最佳截断值分别为支具内和首次支具外X线片矫正率的30%和10%。
首次支具外X线片比支具内X线片能更好地预测最终结果。它为临床医生和患者提供了极好的临床参考。首次支具外X线片应被视为未来预测模型的重要要素。证据水平1：诊断性：采用一致应用的参考标准和盲法的个体横断面研究。
