Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS.
J Pediatr Orthop. 2023 Oct 1;43(9):e747-e750. doi: 10.1097/BPO.0000000000002487. Epub 2023 Jul 31.
Obese and overweight (OOW) patients with adolescent idiopathic scoliosis (AIS) have been shown to initially present with a more advanced Risser score compared to normal weight (NW) patients. The Sanders Maturity Scale (SMS) is now more commonly used by surgeons to assist with treatment decisions because it more reliably predicts skeletal maturity. However, the relationship between SMS and obesity has not been described. We hypothesize that in patients with AIS, OOW patients will have a higher SMS score on initial presentation when compared to NW patients.
Billing data from 2 different institutions were used to identify patients with AIS presenting to a pediatric orthopaedic spine surgeon for an initial visit between July 2012 and March 2020. We excluded those without height/weight data, spine radiographs, or left-hand radiographs for measuring SMS stage. Body mass index-for-age percentiles were calculated and used to group patients into NW (<85th percentile) or OOW (85th percentile and above) per Centers for Disease Control guidelines. After collecting preliminary data, a power analysis was performed using average SMS scores between NW and OOW patients with an alpha of 0.5, determining a needed sample size of approximately 300 male and 300 female subjects.
Five hundred ninety patients (296 female, 294 male) were identified. The SMS stage at presentation was significantly greater in OOW compared to NW patients for both females (5.9±1.8 vs. 5.2±1.7; P =0.003) and males (4.9±1.9 vs. 4.1±1.8; P =0.002). The major curve magnitude for OOW females was significantly different from NW females (36±16 degrees vs. 30±16 degrees; P =0.004). The major curve magnitude was not different for OOW and NW males ( P =0.3).
At initial presentation, OOW patients present at a greater skeletal maturity as measured by the SMS compared with NW patients. OOW female patients present with a greater major curve magnitudes than NW female patients. These results highlight negative implications of the pediatric obesity epidemic as it relates to the AIS population. These findings can be used to counsel families and provide anticipatory guidance for the AIS treatment plan.
Level III-cross-sectional study.
与正常体重（NW）患者相比，患有青少年特发性脊柱侧凸（AIS）的肥胖和超重（OOW）患者最初的 Risser 评分更高。由于 Sanders 成熟度量表（SMS）更可靠地预测骨骼成熟度，因此现在外科医生更常使用它来辅助治疗决策。然而，SMS 与肥胖之间的关系尚未描述。我们假设在患有 AIS 的患者中，与 NW 患者相比，OOW 患者在初次就诊时的 SMS 评分更高。
使用来自 2 个不同机构的计费数据，从 2012 年 7 月至 2020 年 3 月期间，确定了一位儿科骨科脊柱外科医生就诊的 AIS 患者。我们排除了那些没有身高/体重数据、脊柱 X 光片或用于测量 SMS 分期的左手 X 光片的患者。根据疾病控制中心的指南，使用年龄体重指数百分位数将患者分为 NW（<第 85 百分位）或 OOW（第 85 百分位及以上）。在收集初步数据后，使用 NW 和 OOW 患者之间的平均 SMS 评分进行了一项功效分析，α 值为 0.5，确定了大约 300 名男性和 300 名女性受试者的样本量需求。
共确定了 590 名患者（296 名女性，294 名男性）。与 NW 患者相比，OOW 患者的 SMS 分期在女性（5.9±1.8 与 5.2±1.7；P=0.003）和男性（4.9±1.9 与 4.1±1.8；P=0.002）中均显著更高。OOW 女性的主要曲线幅度与 NW 女性显著不同（36±16 度与 30±16 度；P=0.004）。OOW 和 NW 男性的主要曲线幅度没有差异（P=0.3）。
在初次就诊时，OOW 患者的 SMS 测量的骨骼成熟度明显高于 NW 患者。与 NW 女性患者相比，OOW 女性患者的主要曲线幅度更大。这些结果突出了儿科肥胖症流行对 AIS 人群的负面影响。这些发现可用于为 AIS 治疗计划提供咨询和前瞻性指导。
III 级-横断面研究。
