Kwee Thomas C, Beemer Frits A, Beek Frederik J A, Nievelstein Rutger A J
Department of Radiology, KF 01.203.0, Wilhelmina Children's Hospital, University Medical Centre Utrecht, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands.
Pediatr Radiol. 2006 Jan;36(1):8-15. doi: 10.1007/s00247-005-0011-3. Epub 2005 Oct 25.
Flattening of the epiphyses of long bones is seen in several skeletal dysplasias and standardized measurements on a radiograph of the knee to detect skeletal dysplasias using this feature have been described. Since then only two other studies in which this method was used have been published, and both included only a small number of children and neither had a control group. In addition, the Dutch National Working Group on Skeletal Dysplasias began to have doubts about the reliability of the method. We therefore decided to re-evaluate its accuracy in a population of children with and without a skeletal dysplasia.
To determine the diagnostic value of standardized measurements on conventional AP radiographs of the knee in children with a skeletal dysplasia.
We measured the distal femoral metaphysis and epiphysis according to the published method on conventional AP radiographs of the knee in 45 healthy children and 52 children with a skeletal dysplasia. We compared graphically the height of the distal femoral epiphysis with its width and with the width of the femoral metaphysis. Receiver operating characteristic (ROC) curves were calculated for each group of children.
All graphs showed a considerable overlap between children with a skeletal dysplasia and healthy children. The size of the area under the ROC curves for the different groups was small, varying between 0.567 and 0.653.
This method does not discriminate between children with a skeletal dysplasia and healthy children. We therefore consider it to be of little diagnostic value.
在几种骨骼发育不良疾病中可见长骨骨骺变平，并且已经描述了在膝关节X线片上进行标准化测量以利用此特征检测骨骼发育不良。从那时起，仅有另外两项使用该方法的研究发表，这两项研究均仅纳入了少数儿童，且均未设置对照组。此外，荷兰骨骼发育不良国家工作组开始对该方法的可靠性产生怀疑。因此，我们决定在患有和未患有骨骼发育不良的儿童群体中重新评估其准确性。
确定膝关节传统前后位X线片上的标准化测量对患有骨骼发育不良儿童的诊断价值。
我们按照已发表的方法，在45名健康儿童和52名患有骨骼发育不良的儿童的膝关节传统前后位X线片上测量股骨远端干骺端和骨骺。我们以图表形式比较了股骨远端骨骺的高度与其宽度以及股骨干骺端的宽度。为每组儿童计算了受试者工作特征（ROC）曲线。
所有图表均显示患有骨骼发育不良的儿童与健康儿童之间有相当大的重叠。不同组ROC曲线下面积的大小较小，在0.567至0.653之间变化。
该方法无法区分患有骨骼发育不良的儿童和健康儿童。因此，我们认为其诊断价值不大。
