Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Bone Joint Surg Am. 2021 Aug 18;103(16):1543-1551. doi: 10.2106/JBJS.20.01856.
The onset of peak height velocity (PHV) guides the timing of interventions in the growing child. The purpose of the present study was to validate the Diméglio olecranon grading system and to compare these scores with the Risser/triradiate closure (TRC), proximal humerus, and Sanders hand scores.
Eighty children with annual serial radiographs were selected from the Bolton-Brush collection. The olecranon apophysis was graded with use of lateral radiographs of the elbow. The mean age to PHV was determined for each stage, and reliability was calculated with use of an intraclass correlation coefficient (ICC). Olecranon stage was combined with age, sex, and height in a generalized estimating equation (GEE) model to predict PHV. Predictive performance of this model was evaluated with use of tenfold cross-validation such that the model was trained on 90% of the radiographs and was asked to predict the PHV of the remaining 10%.
PHV is closely associated with olecranon stage, with stage 1 occurring 3.0 years before PHV and stage 7 occurring 3.4 years after PHV. Stage 5 was found to occur at PHV. Scoring system reliability was high across an array of observers (ICC = 0.85 ± 0.07). The GEE model showed that this olecranon system outperforms the Risser/TRC system in predicting PHV and is comparable with the humerus and Sanders hand systems. When combined with age and sex, the olecranon system successfully predicted PHV such that 62% of PHV predictions were accurate within 6 months and 90% of PHV predictions were accurate within a year.
Our data show that stage 5 occurs at PHV, contrary to previously published data. When combined with age and sex, the olecranon system successfully predicts PHV within a year in 90% of cases, establishing a single lateral view of the olecranon as a simple alternative to more complex grading systems. Last, we describe novel 3 variations in olecranon morphology and provide a guide for accurate olecranon staging.
Understanding PHV is critical in the treatment of many pediatric orthopaedic disorders. The revised olecranon staging system will allow for more accurate determination of this variable.
峰值身高速度（PHV）的出现指导着生长儿童干预措施的时机。本研究的目的是验证迪梅利奥鹰嘴分级系统，并将这些评分与 Risser/triradiate 闭合（TRC）、肱骨近端和桑德斯手评分进行比较。
从 Bolton-Brush 系列中选择了 80 名有年度系列 X 光片的儿童。使用肘部的侧位 X 光片对鹰嘴突进行分级。为每个阶段确定 PHV 的平均年龄，并使用组内相关系数（ICC）计算可靠性。将鹰嘴突分期与年龄、性别和身高结合在广义估计方程（GEE）模型中，以预测 PHV。使用十折交叉验证评估该模型的预测性能，即模型在 90%的 X 光片中进行训练，并要求其预测其余 10%的 PHV。
PHV 与鹰嘴突分期密切相关，分期 1 在 PHV 前 3.0 年发生，分期 7 在 PHV 后 3.4 年发生。分期 5 发生在 PHV 时。评分系统的可靠性在一系列观察者中均较高（ICC=0.85±0.07）。GEE 模型表明，该鹰嘴突系统在预测 PHV 方面优于 Risser/TRC 系统，与肱骨和桑德斯手系统相当。当与年龄和性别结合时，鹰嘴突系统成功预测 PHV，使得 62%的 PHV 预测在 6 个月内准确，90%的 PHV 预测在一年内准确。
我们的数据显示，分期 5 发生在 PHV 时，与之前发表的数据相反。当与年龄和性别结合时，鹰嘴突系统在 90%的情况下能够在一年内成功预测 PHV，这表明单次外侧鹰嘴突 X 光片是更复杂分级系统的简单替代。最后，我们描述了鹰嘴突形态的 3 种新变异，并提供了准确的鹰嘴突分期指南。
了解 PHV 对于治疗许多儿科骨科疾病至关重要。修订后的鹰嘴突分期系统将能够更准确地确定这一变量。
