特发性脊柱侧凸后路融合术后身高增长：哪种模型最合适？
Height Gain After Spinal Fusion for Idiopathic Scoliosis: Which Model Fits Best?
机构信息
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD.
出版信息
J Pediatr Orthop. 2022 Oct 1;42(9):457-461. doi: 10.1097/BPO.0000000000002225. Epub 2022 Aug 10.
BACKGROUND
Patients will often inquire about the magnitude of height gain after scoliosis surgery. Several published models have attempted to predict height gain using preoperative variables. Many of these models reported good internal validity but have not been validated against an external cohort. We attempted to test the validity of 5 published models against an external cohort from our institution. Models included were Hwang, Van Popta, Spencer, Watanabe, and Sarlak models.
METHODS
We retrospectively queried our institution's records from 2006 to 2019 for patients with adolescent idiopathic scoliosis treated with posterior spinal fusion. We recorded preoperative and postoperative variables including clinical height measurements. We also performed radiographic measurements on preoperative and postoperative radiographic studies. We then tested the ability of the models to predict height gain by evaluating Pearson correlation coefficient, root mean square error, Akaike Information Criterion for each model.
RESULTS
A total of 387 patients were included. Mean clinical height gain was 3.1 (±1.7) cm.All models demonstrated a moderate positive Pearson correlation coefficient, except the Hwang model, which demonstrated a weak correlation. The Spencer model was the only model with acceptable root mean square error (≤0.5) and was also the best fitting with the lowest Akaike Information Criterion (-308). The mean differences in height gain predictions between all models except the Hwang model was ≤1 cm.
CONCLUSIONS
Four of the 5 models demonstrated moderate correlation and had good external validity compared with their development cohorts. Although the Spencer model was the best fitting, the clinical significance of the difference in height predictions compared with other models was low. The Watanabe model was the second best fitting and had the simplest formula, making it the most convenient to use in a clinical setting. We offer a simplified equation to use in a preoperative clinical setting based on this data-ΔHeight (mm)=0.77*(preoperative coronal angle-postoperative coronal angle).
LEVEL OF EVIDENCE
Not Applicable.
背景
患者通常会询问脊柱侧凸手术后的身高增加幅度。已经有几个发表的模型试图使用术前变量来预测身高增加。其中许多模型报告了良好的内部有效性，但尚未经过外部队列验证。我们试图用来自我们机构的外部队列来测试 5 个已发表模型的有效性。包括的模型有 Hwang 模型、Van Popta 模型、Spencer 模型、Watanabe 模型和 Sarlak 模型。
方法
我们回顾性地查询了我们机构从 2006 年到 2019 年的青少年特发性脊柱侧凸患者的记录，这些患者接受了后路脊柱融合术治疗。我们记录了术前和术后的变量，包括临床身高测量值。我们还对术前和术后的影像学研究进行了影像学测量。然后，我们通过评估每个模型的 Pearson 相关系数、均方根误差和赤池信息量准则，来测试模型预测身高增加的能力。
结果
共有 387 名患者入组。临床身高增加的平均值为 3.1（±1.7）cm。所有模型都显示出中度的正 Pearson 相关系数，除了 Hwang 模型显示出弱相关。Spencer 模型是唯一具有可接受的均方根误差（≤0.5）的模型，也是拟合最好的模型，赤池信息量准则最低（-308）。除 Hwang 模型外，所有模型之间的身高增加预测差异平均值都不超过 1cm。
结论
除 Hwang 模型外，其他 4 个模型与它们的开发队列相比，都显示出中度相关性和良好的外部有效性。虽然 Spencer 模型是拟合最好的，但与其他模型相比，身高预测的差异在临床上意义不大。Watanabe 模型是第二拟合最好的，且具有最简单的公式，因此在临床环境中使用最方便。根据这些数据，我们提供了一个简化的公式，用于术前临床环境-Δ身高（mm）=0.77*（术前冠状角-术后冠状角）。
证据水平
不适用。
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