Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong.
The Joint Scoliosis Research Centre of The Chinese University of Hong Kong and Nanjing University, Shatin, Hong Kong.
J Bone Joint Surg Am. 2018 Jul 5;100(13):88. doi: 10.2106/JBJS.17.01271.
The new simplified thumb ossification composite index (TOCI) based on ossification of the thumb epiphyses and adductor sesamoid has demonstrated simplicity, excellent reliability, and high accuracy for predicting skeletal maturity, comparable with the Sanders simplified skeletal maturity system (SSMS). It was our belief that, because the terminology of the SSMS system has been commonly used for skeletal maturity prediction in idiopathic scoliosis in publications over the past decade, the clinical applicability of the TOCI system would increase if the stages in the 2 systems were found to be interchangeable and highly correlated.
Hand radiographs of 125 premenarchal girls with newly diagnosed adolescent idiopathic scoliosis who had been followed longitudinally until skeletal maturity were all scored with use of the Tanner-Whitehouse III (TW3) system (stages E through I), the TOCI, and the SSMS. The scores for the epiphyses of the ulnar 4 digits were compared with those for the thumb and correlated with the timing of peak height velocity. Correlations were analyzed with the chi-square test and Cramer V and Somers delta correlations.
Six hundred and forty-five hand radiographs (an average of 5 for each girl with idiopathic scoliosis) and 11,517 epiphyses were scored. The rate of concordance between TW3 stages F, G, and I for the thumb proximal phalangeal epiphysis and those for all of the epiphyses of the ulnar 4 digits were 72.5%, 72.5%, and 89.9%, respectively. The overall concordance rate (including all epiphyses) was 71.3%, with a very high Cramer V correlation and significance (p < 0.01). High interchangeability was demonstrated for the TOCI and SSMS stages, supported by a high Somers delta correlation (>0.8) with significance (p < 0.05).
The TOCI is highly practical for clinical use, and its stages are highly interchangeable with those of the SSMS.
The TOCI could serve as a simplified "marker" of skeletal maturity on hand radiographs and minimize the learning-curve problems associated with the SSMS in a busy clinical practice.
基于拇指骨骺和内收肌籽骨骨化的新型简化拇指骨化复合指数（TOCI）在预测骨骼成熟度方面表现出了简单性、极好的可靠性和高精度，与 Sanders 简化骨骼成熟系统（SSMS）相当。我们认为，由于 SSMS 系统的术语在过去十年中在特发性脊柱侧凸的出版物中被广泛用于骨骼成熟度预测，如果这两个系统的阶段可以互换且高度相关，那么 TOCI 系统的临床适用性将会增加。
对 125 例经长期随访至骨骼成熟的初潮前女孩的手部 X 线片进行了研究，这些女孩均患有新诊断的青少年特发性脊柱侧凸，所有 X 线片均采用 Tanner-Whitehouse III（TW3）系统（E 至 I 期）、TOCI 和 SSMS 进行评分。比较了尺侧 4 指骨骺的评分与拇指评分，并与身高突增高峰的时间相关。采用卡方检验、Cramer V 和 Somers delta 相关进行相关性分析。
共对 645 张手部 X 线片（每个特发性脊柱侧凸女孩平均 5 张）和 11,517 个骨骺进行了评分。拇指近节指骨骨骺的 TW3 分期 F、G 和 I 与尺侧 4 指所有骨骺的一致性率分别为 72.5%、72.5%和 89.9%。总的一致性率（包括所有骨骺）为 71.3%，Cramer V 相关性和显著性均很高（p < 0.01）。TOCI 和 SSMS 分期的可互换性很高，Somers delta 相关性也很高（>0.8，p < 0.05）。
TOCI 非常实用，其分期与 SSMS 高度可互换。
TOCI 可以作为手部 X 线片上骨骼成熟度的简化“标志物”，并在繁忙的临床实践中减少与 SSMS 相关的学习曲线问题。
