Quan Theodore, Matsumoto Hiroko, Bonsignore-Opp Lisa, Ramo Brandon, Murphy Robert F, Brooks Jaysson T, Welborn Michelle C, Emans John B, Anari Jason B, Johnston Charles E, Akbarnia Behrooz A, McCarthy Richard, Flynn John, Sawyer Jeffrey R, Vitale Michael G, Roye Benjamin D
Department of Orthopaedic Surgery, Columbia University Irving Medical Center.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
J Pediatr Orthop. 2023 Mar 1;43(3):e215-e222. doi: 10.1097/BPO.0000000000002321. Epub 2022 Dec 12.
The term "Tweener" is colloquially used to refer to early-onset scoliosis (EOS) patients whose age and development make them candidates for multiple surgical options. The purpose of this study was to establish expert consensus on a definition to formally characterize the Tweener population.
A 3-round survey of surgeons in an international EOS study group was conducted. Surgeons were provided with various patient characteristics and asked if each was part of their definition for Tweener patients. Responses were analyzed for consensus (≥70%), near-consensus (60% to 69%), and no consensus (<60%).
Consensus was reached (89% of respondents) for including chronological age in the Tweener definition; 8 to 10 years for females and 9 to 11 years for males. Surgeons agreed for inclusion of Sanders score, particularly Sanders 2 (86.0%). Patients who have reached Sanders 4, postmenarche, or have closed triradiate cartilage should not be considered Tweeners. Bone age range of 8 years and 10 months to 10 years and 10 months for females (12 y for males) could be part of the Tweener definition.
This study suggests that the Tweener definition could be the following: patients with open triradiate cartilage who are not postmenarche and have not reached Sanders 4, and if they have one of the following: Sanders 2 or chronological age 8 to 10 years for females (9 to 11 y for males) or bone age 8 years and 10 months to 10 years and 10 months for females (12 y for males). This definition will allow for more focused and comparative research on this population.
Level V-expert opinion.
“中间型患者”一词通俗地用于指代早发性脊柱侧弯（EOS）患者，这些患者的年龄和发育情况使他们适合多种手术选择。本研究的目的是就正式描述中间型患者群体的定义达成专家共识。
对一个国际EOS研究小组的外科医生进行了三轮调查。向外科医生提供了各种患者特征，并询问每种特征是否是他们对中间型患者定义的一部分。对回答进行了共识（≥70%）、接近共识（60%至69%）和无共识（<60%）分析。
在中间型患者定义中纳入实足年龄达成了共识（89%的受访者）；女性为8至10岁，男性为9至11岁。外科医生同意纳入桑德斯评分，特别是桑德斯2级（86.0%）。达到桑德斯4级、月经初潮后或三骨骺软骨已闭合的患者不应被视为中间型患者。女性骨龄范围为8岁10个月至10岁10个月（男性为12岁）可作为中间型患者定义的一部分。
本研究表明，中间型患者的定义可以是：三骨骺软骨未闭合、未月经初潮且未达到桑德斯4级的患者，并且如果他们具有以下情况之一：桑德斯2级或女性实足年龄8至10岁（男性为9至11岁）或女性骨龄8岁10个月至10岁10个月（男性为12岁）。这一定义将有助于对该群体进行更有针对性和对比性的研究。
V级——专家意见。
