多维度评估对特发性脊柱侧凸进展高峰期的预测价值

The values of multiple dimensional indicators for the prediction of peak angle velocity in idiopathic scoliosis girls

中文关键词:  特发性脊柱侧凸  成熟指标  侧凸快速进展  预测

英文关键词:Idiopathic scoliosis  Maturity indicators  Peak angle velocity  Curve progression

中文摘要:

  【摘要】 目的：通过多维度评估特发性脊柱侧凸（idiopathic scoliosis，IS）患儿侧凸进展高峰期（peak angle ve?鄄locity，PAV）的相应成熟度指标，探讨其对PAV的预测价值。方法：选取初诊时月经未至、Risser征0级，Y三角软骨未闭、以半年为周期随访至少5次且进展超过5°的女性IS患儿30例，初诊年龄为10.8±1.5岁（7.8~12.1岁）。随访时收集及测量的指标包括实足年龄、Y三角软骨闭合状态、Risser征、身高、主弯Cobb角和骨龄（dig?鄄ital skeletal age，DSA）评分。计算每个随访周期内的身高增长速度（height velocity，HV）和Cobb角增长速度（angle velocity，AV）。采用逻辑回归分析各维度指标对PAV的预测价值。结果：30例患儿的PAV年龄为11.8±1.3岁（10~15岁），PAV时的身高为150.7±4.8cm，DSA评分为479.4±56.5，主弯Cobb角为26.5°±7.2°，HV为8.3±3.7cm/年，AV为7.8°±5.2°/年。PAV主要发生于Risser征0级（80.0%）和1级（20.0%）。逻辑回归分析结果显示PAV的发生与实足年龄介于11~13岁之间（OR=3.166，P=0.032）、Y软骨闭合（OR=6.365，P<0.01）、Risser征0级（OR=12.963，P<0.01）、DSA评分介于400~500之间（OR=10.758，P=0.011）、HV>6cm/年（OR=4.346，P=0.025）、Cobb角>30°（OR=9.535，P=0.013）呈显著相关。结论：年龄介于11~13岁之间、Risser征0级伴Y软骨闭合、DSA评分介于400~500之间、HV>6cm/年和Cobb角>30°为女性IS患儿侧凸PAV的高危因素，可用于预测PAV的发生，评估侧凸进展风险。

英文摘要:

  【Abstract】 Objectives: To evaluate the role of peak angle velocity(PAV) in a group of idiopathic scoliosis(IS) girls, and to search the multiple dimensional indicators in predicting the high risk of PAV. Methods: 30 IS girls with premenarche status, Risser 0, open triradiate cartilage, curve progression of 5° or more during follow-up and with at least 5 visits into our center were included. The average age at the first visit was 10.8 years. At each visit, the following data were collected and recorded: chronologic age, status of triradiate cartilage, Risser sign, height, the Cobb angle of major curve and digital skeletal age(DSA) score. Furthermore, the height velocity(HV) and angle velocity(AV) of each follow-up period were calculated. The logistic regression analysis was used to identify the independent indicators of PAV. Results: The average age was 11.8 years at PAV. The average height, DSA score and Cobb angle at PAV was 150.7±4.8cm, 479.4±56.5 and 26.5±7.2°, respectively. The average HV and AV at PAV was 8.3±3.7cm/year and 7.8±5.2°/year. Additionally, the Risser sign was 0 and 1 in 80.0% patients and 20.0% patients at PAV, respectively. According to the logistic regression model, chronologic age between 11 and 13 years(OR=3.166, P=0.032), closed triradiate cartilage(OR=6.365, P<0.01), Risser 0(OR=12.963, P<0.01), DSA score between 400 and 500(OR=10.758, P=0.011), HV >6cm/year(OR=4.346, P=0.025), Cobb angle of major curve >30°(OR=9.535, P=0.013) were significantly correlated with the occurrence of PAV. Conclusions: Multiple dimensional indicators together predict the PAV in IS girls including age between 11 and 13 years, Risser 0 with closed triradiate cartilage, DSA score between 400 and 500, HV more than 6cm per year and Cobb angle of major curve more than 30°.