机器学习在额眶缝早闭中的应用：表型严重程度是否可预测长期美观结局？
Machine Learning in Metopic Craniosynostosis: Does Phenotypic Severity Predict Long-Term Esthetic Outcome?
机构信息
Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia.
Division of Plastic Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA.
出版信息
J Craniofac Surg. 2023;34(1):58-64. doi: 10.1097/SCS.0000000000008868. Epub 2022 Aug 10.
BACKGROUND
There have been few longitudinal studies assessing the effect of preoperative phenotypic severity on long-term esthetic outcomes in metopic craniosynostosis. This study evaluates the relationship between metopic severity and long-term esthetic outcomes using interfrontal angle (IFA) and CranioRate, a novel metopic synostosis severity measure.
METHODS
Patients with metopic craniosynostosis who underwent bifrontal orbital advancement and remodeling between 2012 and 2017 were reviewed. Preoperative computed tomography head scans were analyzed for IFA and CranioRate, a machine learning algorithm which generates quantitative severity ratings including metopic severity score (MSS) and cranial morphology deviation (CMD). Long-term esthetic outcomes were assessed by craniofacial surgeons using blinded 3-rater esthetic grading of clinical photos. Raters assessed Whitaker score and the presence of temporal hollowing, lateral orbital retrusion, frontal bone irregularities and/or "any visible irregularities."
RESULTS
Preoperative scans were performed at a mean age of 7.7±3.4 months, with average MSS of 6/10, CMD of 200/300, and IFA of 116.8±13.8 degrees. Patients underwent bifrontal orbital advancement and remodeling at mean 9.9±3.1 months. The average time from operation to esthetic assessment was 5.4±1.0 years. Pearson correlation revealed a significant negative correlation between MSS and age at computed tomography ( r =-0.451, P =0.004) and IFA ( r =-0.371, P =0.034) and between IFA and age at surgery ( r =-0.383, P =0.018). In multinomial logistic regression, preoperative MSS was the only independent predictor of visible irregularities (odds ratio=2.18, B =0.780, P =0.024) and preoperative IFA alone significantly predicted Whitaker score, with more acute IFA predicting worse Whitaker score (odds ratio=0.928, B =-0.074, P =0.928).
CONCLUSIONS
More severe preoperative phenotypes of metopic craniosynostosis were associated with worse esthetic dysmorphology. Objective measures of preoperative metopic severity predicted long-term esthetic outcomes.
背景
鲜有研究评估术前表型严重程度对额骨矢状缝早闭远期美学效果的影响。本研究使用额眶角（IFA）和颅率（一种新的额缝早闭严重程度评估方法）评估额缝严重程度与远期美学效果之间的关系。
方法
回顾了 2012 年至 2017 年间接受双侧额眶骨切开和重塑的额骨矢状缝早闭患者。对术前头颅 CT 扫描进行分析，以获得 IFA 和颅率，颅率是一种生成定量严重程度评分的机器学习算法，包括额缝严重程度评分（MSS）和颅骨形态偏差（CMD）。由颅面外科医生使用盲法 3 名评分者对临床照片进行美学分级，评估远期美学效果。评分者评估 Whitaker 评分以及颞部凹陷、外侧眶窝后缩、额骨不规则和/或“任何可见的不规则”的存在情况。
结果
术前扫描时平均年龄为 7.7±3.4 个月，平均 MSS 为 6/10，CMD 为 200/300，IFA 为 116.8±13.8 度。患者平均在 9.9±3.1 个月时行双侧额眶骨切开和重塑术。从手术到美学评估的平均时间为 5.4±1.0 年。Pearson 相关性分析显示，MSS 与 CT 检查时的年龄（ r =-0.451， P =0.004）和 IFA（ r =-0.371， P =0.034）呈显著负相关，IFA 与手术时的年龄（ r =-0.383， P =0.018）呈显著负相关。多变量逻辑回归分析显示，术前 MSS 是可见畸形的唯一独立预测因子（优势比=2.18， B =0.780， P =0.024），而术前 IFA 单独显著预测 Whitaker 评分，较陡的 IFA 预示 Whitaker 评分更差（优势比=0.928， B =-0.074， P =0.928）。
结论
额缝早闭术前表型越严重，远期美学畸形越严重。术前额缝严重程度的客观指标可预测远期美学效果。
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