Wang Weijun, Zhen Xin, Sun Xu, Zhu Zezhang, Zhu Feng, Lam T P, Cheng Jack C Y, Qiu Yong
The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Stud Health Technol Inform. 2012;176:183-7.
A grading system for ossification of the iliac apophysis (Risser sign) was developed for skeletal maturity assessment in the United States (US) then adopted with modifications in France (Fr) and other countries. Despite the same name, these systems have important differences. With the aim to analyzing the difference between US and Fr Risser grading systems in determining the growth maturity of girls with adolescent idiopathic scoliosis (AIS), Fifty-three AIS girls undergoing posterior spinal correction with autogenous bone graft were recruited. The Risser grades were recorded for the non-dominant side iliac crest apophysis according to the US and Fr grading systems. Growth activity was determined by standard histologic grades (HGs) on iliac crest cartilage. As a result, Kappa statistics showed poor agreement between two grading systems. The US system showed higher correlation with HGs compared to Fr system by Spearman correlation analysis. It was also found that growth cessation could be determined by Risser grade 5 of US system or Risser grade 4 of Fr system. Furthermore, by employing Receiver Operating Characteristic (ROC) curve analysis, it was found that the Risser grade 4-5 of US system with two years after menarche could be used in determining growth cessation with the highest sensitivity, specificity and accuracy. Hence it was concluded that the US Risser grading system was better in determining maturity of girls with AIS than Fr Risser grading system. By combining years since menarche, the accuracy of Risser grades in determining growth cessation could be enhanced, and the time of weaning from a brace could be advanced.
美国开发了一种用于评估髂骨骨骺骨化的分级系统（Risser征），用于骨骼成熟度评估，随后在法国及其他国家进行了修改后采用。尽管名称相同，但这些系统存在重要差异。为了分析美国和法国Risser分级系统在确定青少年特发性脊柱侧凸（AIS）女孩生长成熟度方面的差异，招募了53名接受自体骨移植后路脊柱矫正的AIS女孩。根据美国和法国分级系统记录非优势侧髂嵴骨骺的Risser分级。通过髂嵴软骨的标准组织学分级（HG）确定生长活性。结果，Kappa统计显示两种分级系统之间的一致性较差。通过Spearman相关性分析，美国系统与HG的相关性高于法国系统。还发现美国系统的Risser 5级或法国系统的Risser 4级可确定生长停止。此外，通过采用受试者操作特征（ROC）曲线分析，发现初潮后两年的美国系统Risser 4-5级在确定生长停止方面具有最高的敏感性、特异性和准确性。因此得出结论，美国Risser分级系统在确定AIS女孩成熟度方面优于法国Risser分级系统。结合初潮后的年份，Risser分级在确定生长停止方面的准确性可以提高，并且可以提前停止支具治疗的时间。
