Li Samuel Q, Nicholson Allen D, Cooperman Daniel R, Liu Raymond W
School of Medicine.
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
J Pediatr Orthop. 2019 Jan;39(1):46-50. doi: 10.1097/BPO.0000000000001058.
The calcaneal apophysis ossification staging system is a novel method for assessing skeletal maturity. However, it was created using the same historic patient population that was used to create the Greulich and Pyle atlas of the hand and wrist, predominantly white children. It is unclear if the calcaneal apophysis ossification staging system is still applicable to the modern pediatric population and to children of other races.
We retrospectively studied 1327 benign lateral foot x-rays from modern white and black children. Calcaneal stage was determined and age, race, and sex were collected for each patient. A 2-tailed Student t test was used to compare between cohorts the differences in age for each calcaneal stage.
Mean age was 11.55±4.39 years. Modern white females graded as stage 3 and 4 were significantly delayed in their bone age (stage 3 P<0.002; stage 4 P<0.003) when compared with their historic counterparts. Skeletal maturity was consistent between modern and historic white males for stages 1 to 4. Modern black females graded as stage 1 to 4 were significantly advanced in their skeletal age when compared with modern white females (stage 1 P<0.038; stage 2 P<0.005; stage 3 P<0.002; stage 4 P<0.002). Modern black males graded as stages 1, 3, and 4 were also significantly advanced in their bone age when compared with their modern white counterparts (stage 1 P<0.003; stage 3 P<0.012; stage 4 P<0.029).
Modern white females mature more slowly in the later stages when compared with their historic counterparts. No significant difference is seen between modern and historic white males. Modern black females and males were skeletally advanced compared with modern white females and males. We have shown that the calcaneal ossification staging system can be used to assess for skeletal maturity in the modern pediatric population with only mild corrections for white females and more significant adjustments for black females and males.
Level III-retrospective chart review.
跟骨骨骺骨化分期系统是一种评估骨骼成熟度的新方法。然而，它是使用与创建格吕利希和派尔手部及腕部图谱相同的历史患者群体创建的，主要是白人儿童。目前尚不清楚跟骨骨骺骨化分期系统是否仍适用于现代儿科人群以及其他种族的儿童。
我们回顾性研究了1327例现代白人及黑人儿童的足部外侧良性X线片。确定跟骨分期，并收集每位患者的年龄、种族和性别信息。采用双尾学生t检验比较各队列中每个跟骨分期的年龄差异。
平均年龄为11.55±4.39岁。与历史对照组相比，现代白人女性处于3期和4期时骨龄明显延迟（3期P<0.002；4期P<0.003）。1至4期现代白人男性与历史对照组的骨骼成熟度一致。与现代白人女性相比，处于1至4期的现代黑人女性骨骼年龄明显提前（1期P<0.038；2期P<0.005；3期P<0.002；4期P<0.002）。与现代白人男性相比，处于1、3和4期的现代黑人男性骨龄也明显提前（1期P<0.003；3期P<�0.012；4期P<0.029）。
与历史对照组相比，现代白人女性在后期成熟较慢。现代白人男性与历史对照组之间未见显著差异。与现代白人女性和男性相比，现代黑人女性和男性骨骼发育提前。我们已经表明，跟骨骨化分期系统可用于评估现代儿科人群的骨骼成熟度，只需对白人女性进行轻度校正，对黑人女性和男性进行更显著的调整。
III级——回顾性图表审查。
