不同青少年特发性脊柱侧凸患者身高丢失预测方法的比较分析

Comparison analysis between different predictive methods of height loss in adolescent idiopathic scoliosis patients

中文关键词:  青少年特发性脊柱侧凸  身高丢失  Bjure法  Kono法  Ylikoski法  Stokes法

英文关键词:Adolescent idiopathic scoliosis  Height loss  Bjure method  Kono method  Ylikoski method  Stokes method

中文摘要:

  【摘要】目的：比较Bjure法、Kono法、Ylikoski法和Stokes法对青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者身高丢失的预测能力，并探讨其影响因素。方法：回顾性分析2016年1月~2020年5月于甘肃省中医院青少年骨病诊疗中心行手术治疗的250例女性AIS患者，平均年龄15.0±2.6岁（12~18岁）。根据侧凸的弯型分为单弯组、双弯组；以Cobb角60°为界，分为主弯Cobb角≥60°组和主弯Cobb角＜60°组。测量侧凸Cobb角、脊柱长度（spinal length，SL）、脊柱高度（spinal height，SH）等影像学参数，将身高丢失（ΔH）定义为SL与SH的差值。分别采用Bjure法、Kono法、Ylikoski法和Stokes法公式计算预测值，对四种方法的预测值和实际测量值进行配对t检验，采用Pearson相关系数进行相关性分析。结果：250例患者主弯侧凸Cobb角53.9°±15.8°，ΔH值为4.4±2.8cm。应用Bjure法、Kono法、Ylikoski法和Stokes法计算的ΔH值分别为2.9±2.2cm、1.9±1.3cm、1.4±1.4cm、2.5±1.8cm。配对样本t检验示ΔH实际测量值与四种公式的预测值之间均有显著统计学差异（P<0.001），而Pearson相关性分析示ΔH实际测量值与四种方法的预测值之间有显著相关性（P<0.001）。亚组分析结果显示，单弯组、双弯组、主弯Cobb角≥60°组及主弯Cobb角<60°组ΔH实际测量值与应用四种方法计算的ΔH预测值有明显差异性（P<0.05）；在主弯Cobb角≥60°患者组内，应用Bjure法计算的身高丢失值最接近ΔH实际测量值（5.2cm vs 5.9cm）。结论：Bjure法、Kono法、Ylikoski法和Stokes法均无法准确预测女性AIS患者的身高丢失情况。与其他三种方法相比，Bjure法应用于主弯侧凸Cobb角≥60°的单弯型女性患者中时可获得相对可靠的预测值。

英文摘要:

  【Abstract】 Objectives: To compare the Bjure method, Kono method, Ylikoski method, and Stokes method in the prediction of height loss in patients with adolescent idiopathic scoliosis(AIS), and to evaluate their influencing factors. Methods: A total of 250 female AIS patients surgically treated in the Department of Pediatric Orthopedics, Gansu Hospital of Traditional Chinese Medicine from January 2016 to May 2020 were retrospectively reviewed. The age was 15.0±2.6 years(12-18 years) of the cohort. The patients were divided into single curve group and double curves group based on the curve type; And Cobb angle < 60° group and Cobb angle ≥ 60° group. The radiographic parameters including Cobb angle, spinal length(SL) and spinal height(SH) were measured, and the height loss(ΔH) was defined as SL minus SH. Using the fomulas of Bjure method, Kono method, Ylikoski method, and Stokes method to calculate height losses respectively, and comparing between the predicitive values of the 4 methods and real measurement with paired t test while applying Pearson coefficients for correlation analysis. Results: The average Cobb angle was 53.9°±15.8° and the value of ΔH was 4.4±2.8cm for the cohort. The height loss calculated from Bjure method, Kono method, Ylikoski method and Stokes method were 2.9±2.2cm, 1.9±1.3cm, 1.4±1.4cm and 2.5±1.8cm, respectively. The paired t test demonstrated significant differences between ΔH and the calculated height losses(P<0.001). Significant correlations were found between ΔH and the calculated height losses(P<0.001). The subgroup analysis showed significant differences between ΔH and the calculated height losses in single curve group, double curves group, Cobb angle of main curve ≥60° group and Cobb angle of main curve <60° group(P<0.05), and the calculated height loss by Bjure method was the closest to the real measurement value of ΔH in the Cobb angle≥60° group(5.2cm vs 5.9cm). Conclusions: None of the Bjure method, Kono method, Ylikoski method and Stokes method is able to predict the height loss in female AIS patients accurately, and the Bjure method seems to be relatively reliable in female AIS patients with Cobb angle of main curve ≥60° and single curve comparing with the other 3 methods.