Birch John G, Makarov Marina R, Sanders James O, Podeszwa David A, Honcharuk Erin M, Esparza Melissa, Tran Elaine Y, Jo Chan-Hee, Rodgers Jennifer A
Texas Scottish Rite Hospital for Children, Dallas, Texas.
University of North Carolina, Durham, North Carolina.
J Bone Joint Surg Am. 2021 Sep 15;103(18):1713-1717. doi: 10.2106/JBJS.20.01923.
Several methods are available to estimate leg lengths at maturity to facilitate the determination of timing of epiphysiodesis. We compared the Paley multiplier, Sanders multiplier, and White-Menelaus methods in an epiphysiodesis-aged cohort. We assessed intra- and interrater reliability for Sanders skeletal stages and Greulich and Pyle atlas skeletal age.
Actual growth was recorded in healthy, unoperated femoral and tibial segments from an epiphysiodesis database. The predicted and actual lengths were compared with use of the Paley multiplier and White-Menelaus methods, Greulich and Pyle skeletal age, and the Sanders multiplier using Sanders stages. Intra- and interrater reliability were assessed in a separate group of 76 skeletal age films.
The cohort included 148 femora and 195 tibiae in 197 patients. Femoral length at maturity was slightly underestimated by the Sanders multiplier and staging, was overestimated by the Paley multiplier and skeletal age, and was most accurately predicted with use of the White-Menelaus formula and skeletal age. All methods overestimated tibial length at maturity. The whole-leg prediction accuracy of the Sanders multiplier and White-Menelaus formula were comparable and were more accurate than that of the Paley multiplier. For Sanders skeletal staging, the interrater reliability varied from 0.86 to 0.88 and the intrarater reliability varied from 0.87 to 0.96. For Greulich and Pyle skeletal age, the interrater reliability varied from 0.87 to 0.89 and the intrarater reliability varied from 0.91 to 0.95.
Use of the Sanders multiplier and skeletal stages was more accurate than the Paley multiplier and skeletal age in this cohort. Use of the White-Menelaus formula and skeletal age was slightly more accurate in predicting femoral length and slightly less accurate in predicting tibial length compared with the Sanders multiplier. Intra- and interrater reliability were similar between Sanders skeletal stages and Greulich and Pyle atlas skeletal age. The White-Menelaus formula and skeletal age was the recommended method for predicting lower-extremity segment lengths at maturity and epiphysiodesis effect. Although easier to recall without referencing an atlas and not sex-specific, Sanders skeletal staging does not correspond directly to years of growth remaining, and thus cannot be used with the White-Menelaus formula.
The Greulich and Pyle atlas to determine skeletal age and the White-Menelaus formula to determine growth remaining are reliable predictors of epiphysiodesis effect in the lower extremities.
有多种方法可用于估计成熟时的腿长，以帮助确定骺板固定术的时机。我们在一个适合进行骺板固定术年龄的队列中比较了佩利乘数法、桑德斯乘数法和怀特 - 梅内劳斯法。我们评估了桑德斯骨骼分期以及格罗利希和派尔图谱骨骼年龄的评分者内和评分者间可靠性。
从一个骺板固定术数据库中记录健康、未手术的股骨和胫骨段的实际生长情况。使用佩利乘数法和怀特 - 梅内劳斯法、格罗利希和派尔骨骼年龄以及使用桑德斯分期的桑德斯乘数法比较预测长度和实际长度。在另一组76张骨骼年龄X线片上评估评分者内和评分者间可靠性。
该队列包括197例患者的148根股骨和195根胫骨。桑德斯乘数法和分期略微低估了成熟时的股骨长度，佩利乘数法和骨骼年龄高估了成熟时的股骨长度，而使用怀特 - 梅内劳斯公式和骨骼年龄预测最为准确。所有方法都高估了成熟时的胫骨长度。桑德斯乘数法和怀特 - 梅内劳斯公式的全腿预测准确性相当，且比佩利乘数法更准确。对于桑德斯骨骼分期，评分者间可靠性在0.86至0.88之间，评分者内可靠性在0.87至0.96之间。对于格罗利希和派尔骨骼年龄，评分者间可靠性在0.87至0.89之间，评分者内可靠性在0.91至0.95之间。
在这个队列中，使用桑德斯乘数法和骨骼分期比佩利乘数法和骨骼年龄更准确。与桑德斯乘数法相比，使用怀特 - 梅内劳斯公式和骨骼年龄在预测股骨长度时略更准确，而在预测胫骨长度时略不准确。桑德斯骨骼分期与格罗利希和派尔图谱骨骼年龄的评分者内和评分者间可靠性相似。怀特 - 梅内劳斯公式和骨骼年龄是预测成熟时下肢节段长度和骺板固定术效果的推荐方法。虽然无需参考图谱即可更容易记住且不具有性别特异性，但桑德斯骨骼分期并不直接对应剩余的生长年数，因此不能与怀特 - 梅内劳斯公式一起使用。
使用格罗利希和派尔图谱确定骨骼年龄以及使用怀特 - 梅内劳斯公式确定剩余生长是下肢骺板固定术效果的可靠预测指标。
