Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
Eur Spine J. 2020 Apr;29(4):770-778. doi: 10.1007/s00586-020-06289-8. Epub 2020 Jan 16.
Distal radius and ulna (DRU) classification scheme has been proposed for predicting skeletal maturity in patients with idiopathic scoliosis (IS). However, the utilization of DRU classification scheme in the assessment of growth peak and curve progression in IS was still inconclusive. This study aimed to correlate the distal radius and ulna stages with several indicators for growth potential and to evaluate the predictive value of DRU system for curve progression in braced female IS patients.
This was a consecutive longitudinal study including physically immature IS girls receiving standardized bracing treatment and regularly followed up every 3-6 months until brace weaning. The following data of each visit were collected: chronologic age, standing height, Cobb angle, spinal length, Risser sign, digital skeletal age (DSA) scores and DRU scores. The height velocity (HV), spinal growth velocity (SGV) and angle velocity (AV) of each visit were calculated. The correlation among radius stage, ulna stage, Risser sign, height, spinal length, HV, SGV and AV was studied.
Forty braced IS girls with 349 longitudinal whole spine X-rays were reviewed. The average DRU scores at initial visit were R6.5 ± 1.1 and U4.5 ± 1.2 for radius and ulna, respectively. Both the radius stages between R5 and R8 and ulna stages between U3 and U6 indicated high SGV and high HV. The DSA scores were 402.1 ± 48.8 and 430.8 ± 44.4 at R7 and R8, respectively. The AV values were - 5.9 ± 12.4°/y and - 0.4 ± 1.5°/y at R5 and R6, which increased to 5.9 ± 17.3°/y, 3.1 ± 15.7°/y and 4.2 ± 12.2°/y at R7, R8 and R9, respectively. The DSA scores were 387.3 ± 65.7 for U5 and 432.9 ± 48.5 for U6, respectively. The AV values were - 3.1 ± 0.3°/y at U3, - 1.7 ± 9.3°/y at U4, 2.3 ± 16.1°/y at U5, 5.4 ± 15.5°/y at U6 and 4.4 ± 12.9°/y at U7.
Both distal radius and ulna scores correlate with the longitudinal growth potential, and thus, the DRU scoring scheme is an alternative predictor for growth potential and curve progression in girls with IS. These slides can be retrieved under Electronic Supplementary Material.
远端桡尺骨（DRU）分类方案已被提出用于预测特发性脊柱侧凸（IS）患者的骨骼成熟度。然而，DRU 分类方案在评估 IS 中的生长高峰和曲线进展中的应用仍存在争议。本研究旨在探讨远端桡骨和尺骨的分期与生长潜力的几个指标相关，并评估 DRU 系统对接受支具治疗的女性 IS 患者曲线进展的预测价值。
这是一项连续的纵向研究，纳入了接受标准化支具治疗且定期随访的未成年 IS 女孩，每 3-6 个月随访一次，直至支具脱除。每次随访时收集以下数据：年龄、身高、Cobb 角、脊柱长度、Risser 征、数字骨龄（DSA）评分和 DRU 评分。计算每次随访的身高速度（HV）、脊柱生长速度（SGV）和角度速度（AV）。研究桡骨分期、尺骨分期、Risser 征、身高、脊柱长度、HV、SGV 和 AV 之间的相关性。
回顾了 349 次完整脊柱全长 X 线片，共纳入 40 名接受支具治疗的 IS 女孩。初始时桡骨的平均 DRU 评分为 R6.5±1.1，尺骨的平均 DRU 评分为 U4.5±1.2。桡骨的 R5 到 R8 分期和尺骨的 U3 到 U6 分期均与较高的 SGV 和 HV 相关。桡骨的 DSA 评分为 R7 时为 402.1±48.8，R8 时为 430.8±44.4。尺骨的 DSA 评分为 U3 时为 387.3±65.7，U4 时为 432.9±48.5。桡骨的 AV 值在 R5 和 R6 时分别为-5.9±12.4°/y 和-0.4±1.5°/y，在 R7、R8 和 R9 时分别增加至 5.9±17.3°/y、3.1±15.7°/y 和 4.2±12.2°/y。尺骨的 AV 值在 U3 时为-3.1±0.3°/y，在 U4 时为-1.7±9.3°/y，在 U5 时为 2.3±16.1°/y，在 U6 时为 5.4±15.5°/y，在 U7 时为 4.4±12.9°/y。
桡骨和尺骨评分均与纵向生长潜力相关，因此，DRU 评分系统是评估 IS 患者生长潜力和曲线进展的替代预测指标。这些幻灯片可在电子补充材料中检索。
