Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
Eur Spine J. 2024 Dec;33(12):4740-4749. doi: 10.1007/s00586-024-08496-z. Epub 2024 Sep 21.
The aim of this study was to identify associated risk factors of distal adding-on phenomenon in Lenke 1A/B and 2A/B adolescent idiopathic scoliosis (AIS) patients and establish the corresponding prediction model.
The clinical data of 119 Lenke 1A/B and 2A/B AIS patients were retrospectively analyzed. Preoperative, first erect (FE) radiographic parameters and radiographic parameters at the last follow-up were measured. Patients were divided into the adding-on group and the no adding-on group according to whether the adding-on phenomenon was observed at the last follow-up. Univariate analysis and multivariate logistic regression analysis were used to establish the corresponding prediction model.
Adding-on affected 39 (32.8%) patients at the last follow-up. Risser sign and 19 radiographic parameters showed significant differences between the two groups by univariate analysis. Stepwise logistic regression analysis found that the Risser sign and so on five predictor variable, and the nomogram was drawn. The calibration curve showed that the model fitted well. The area under the receiver operating characteristic (ROC) curve is 0.949. And the decision curve analysis curve model within the threshold range for interventions to improve clinical outcomes. There was no significant difference in SRS-22 scores between the two groups.
This study established a prediction model with adding-on in Lenke 1A/B and 2A/B AIS patients. The nomogram contains five predictive variables, which can effectively predict the probability of adding-on phenomenon during follow-up, and may have greater clinical value for the treatment and prevention of adding-on phenomenon.
本研究旨在确定 Lenke 1A/B 和 2A/B 青少年特发性脊柱侧凸（AIS）患者远端附加现象的相关危险因素，并建立相应的预测模型。
回顾性分析 119 例 Lenke 1A/B 和 2A/B AIS 患者的临床资料。测量术前、首次站立位（FE）影像学参数和末次随访时的影像学参数。根据末次随访时是否观察到附加现象，将患者分为附加组和无附加组。采用单因素分析和多因素 logistic 回归分析建立相应的预测模型。
末次随访时，39 例（32.8%）患者出现附加现象。单因素分析显示，两组患者的 Risser 征和 19 项影像学参数存在显著差异。逐步 logistic 回归分析发现，Risser 征等五个预测变量，绘制了列线图。校准曲线表明模型拟合良好。受试者工作特征（ROC）曲线下面积为 0.949。决策曲线分析曲线模型在干预改善临床结局的阈值范围内。两组 SRS-22 评分无显著差异。
本研究建立了一个包含五个预测变量的 Lenke 1A/B 和 2A/B AIS 患者附加现象预测模型。该列线图可以有效预测随访期间附加现象的发生概率，可能对附加现象的治疗和预防具有更大的临床价值。
