马鸿儒,朱泽章,史本龙,刘 臻,邱 勇.GAP评分及其对成人脊柱畸形矫形术后力学并发症预测的可信度研究[J].中国脊柱脊髓杂志,2020,(6):481-487.
GAP评分及其对成人脊柱畸形矫形术后力学并发症预测的可信度研究
中文关键词:  成人脊柱畸形  GAP评分  力学并发症  可靠性
中文摘要:
  【摘要】 目的:评估GAP(global alignment and proportion)评分的可信度和可重复性,并探究其在成人脊柱畸形(adult spinal deformity,ASD)矫形术后力学并发症预测中的可靠性。方法:回顾性分析2014年12月~2016年12月在我院行脊柱后路矫形内固定术且随访超过2年的ASD患者98例,其中男性31例,女性67例,年龄38.8±8.6(20~71)岁,随访时间34.4±9.3个月。其中退变性脊柱侧后凸29例、先天性脊柱侧后凸28例、特发性脊柱侧凸19例、创伤后脊柱后凸9例、神经源性脊柱侧凸9例、休门氏病后凸畸形2例,综合征型脊柱侧凸2例(马凡综合征和类马凡综合征各1例)。通过患者术后全脊柱侧位X线片测量骨盆入射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、腰椎前凸角(lumbar lordosis,LL)、下腰椎前凸角(lower lumbar lordosis,LLL)和躯干整体倾斜(global tilt,GT)等影像学参数,并计算得出GAP评分,比较GAP评分的观察者间可信度和观察者内可重复性。根据GAP评分结果将患者分为3组:协调组(GAP评分0~2分);中等不协调组(GAP评分3~6分);严重不协调组(GAP评分7~13分),记录所有患者随访中出现的力学并发症,包括内固定失败、近端交界性后凸/失败(proximal junctional kyphosis/failure,PJK/PJF)、远端交界性后凸/失败(distal junctional kyphosis/failure,DJK/DJF),比较各组间力学并发症的发生率。收集患者术前及末次随访时疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)问卷表和健康调查简表(the MOS item short form health survey,SF-36)评估结果,比较三组间生活质量评分。结果:3名观察者共进行了588次(98×3×2)次评分,纳入协调组共192(32.7%)次、中等不协调组共250(42.5%)次、严重不协调组共146(24.8%)次。观察者间GAP评分可信度Kappa值为0.765(基本可信),观察者内可重复性Kappa值为0.822(完全可信)。随访中发现力学并发症15例,包括内固定断裂5例(8.2%)、PJK 9例(9.2%)、螺钉松动1例(1.0%)。协调组、中等不协调组和严重不协调组并发症发生率分别为9.1%(3/33)、14.6%(6/41)和25.0%(6/24),三组之间差异无统计学意义(χ2=2.74,P=0.254)。三组患者术前生活质量评分未见明显差异(ODI:P=0.167;VAS:P=0.668;SF-36生理功能评分:P=0.896;SF-36心理功能评分:P=0.211)。末次随访时发现ODI(P=0.038)和SF-36生理功能评分(P=0.020)在三组间存在差异,而VAS(P=0.729)和SF-36心理功能评分(P=0.277)无组间差异。结论:GAP评分具有良好的观察者内和观察者间一致性,但评分结果与术后力学并发症发生风险无明显相关性。
Reliability of the global alignment and proportion score in predicting mechanical complications after correction surgery of adult spinal deformities
英文关键词:Adult spinal deformity  Global alignment and proportion  Mechanical complication  Reliability
英文摘要:
  【Abstract】 Objectives: To determine the intra- and inter-observer reliabilities of global alignment and proportion(GAP) score in predicting the mechanical complications after correction surgery of adult spinal deformities(ASD). Methods: A total of 98 ASD patients undergone correction surgery between December 2014 and December 2016 with at least 2 years follow-up were retrospectively reviewed, including 31 male and 67 female subjects that aged 38.8±8.6(20-71) years on average. Patients′ age were documented and radiographic parameters including PI, SS, LL, LLL and GT were independently measured twice by 3 spine surgeons on postoperative lateral full-spine X-rays to determine the GAP scores and classifications. Patients were classified into 3 groups: proportion group with GAP scores between 0-2, moderate disproportion group with GAP scores between 3-6, severe disproportion group with GAP scores between 7-13. All mechanical complications including implant-related failures, PJK/PJF and DJK/DJF were documented. The intra- and inter-observer reliabilities were analyzed and the incidence of mechanical complications between the 3 groups was compared with Chi-square tests. The visual analogue scale(VAS), Oswestry disability index(ODI) and the MOS item short form health survey(SF-36) were compared among three groups. Results: Of all 588(98×3×2) measurements of GAP scores obtained, 192(32.7%) measurements were classified into the proportion group, 250(42.5%) into the moderate disproportion group, and 146(24.8%) into the severe disproportion group. The Kappa coefficients were 0.765 for inter-observer and 0.822 for intra-observer reliabilities. A total of 15 patients were identified to have mechanical complications during follow-up, and the incidences were 9.1%(3/33), 14.6%(6/41) and 25.0%(6/24) for proportion group, moderate disproportion group and severe disproportion group, respectively (χ2=2.74, P=0.254). At pre-operation, the VAS(P=0.668), ODI(P=0.167), SF-36 PCS(P=0.896) and SF-36 MCS(P=0.211) were not significantly different between the 3 groups. During the last follow up, the ODI(P=0.038) and SF-36 PCS(P=0.020) were significantly different between groups, no statistically significant difference was found in terms of VAS(P=0.729) and SF-36 MCS(P=0.277). Conclusions: The GAP scores have good to excellent intra- and inter-observer reliabilities in ASD patients undergoing correction surgery. The GAP scores are unable to predict the occurrence of mechanical complications during follow-up.
投稿时间:2020-03-18  修订日期:2020-05-28
DOI:
基金项目:江苏省自然科学基金青年基金资助项目(编号:BK20170126);宿迁市科技支撑计划项目(编号:S201612)
作者单位
马鸿儒 南京大学医学院附属鼓楼医院脊柱外科 210008 南京市 
朱泽章 南京大学医学院附属鼓楼医院脊柱外科 210008 南京市 
史本龙 南京大学医学院附属鼓楼医院脊柱外科 210008 南京市 
刘 臻  
邱 勇  
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