系统分离估计 AP 髋关节 X 线片上骨骼成熟度的关键参数。

Department of Orthopaedics, University Hospitals Cleveland Medical Center.

Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.

J Pediatr Orthop. 2021 Sep 1;41(8):483-489. doi: 10.1097/BPO.0000000000001876.

BACKGROUND

The ability to estimate skeletal maturity using a hip radiograph does not yet exist, but may have utility in the treatment of scoliosis, slipped capital femoral epiphysis, and lower limb deformity. We sought to develop a fast, accurate, and reproducible method.

METHODS

Fourteen hip radiologic parameters were evaluated on serial anteroposterior hip radiographs from 3 years before to 2 years after the skeletal age associated with 90% of final height, a validated skeletal maturity definition which correlates with the timing of peak height velocity. The Greulich and Pyle (GP) left hand bone age was obtained for comparison. Stepwise linear regression and generalized estimating equation analyses were used to isolate key hip and demographic parameters, creating the "optimized Oxford" skeletal maturity system. The accuracy of the optimized Oxford system in predicting years from 90% of final height was evaluated and compared with systems of demographics only, the modified Oxford, demographics+modified Oxford, and demographics+GP.

RESULTS

A total of 284 hip radiographs from 41 girls (range: 7 to 15 y) and 38 boys (range: 9 to 17 y) were included. Following multivariate analyses, 5 of the original 14 hip radiographic parameters remained significant. The predictions made by the optimized Oxford model had greater accuracy and fewer outlier predictions (predictions >1 y off from actual years from 90% of final height) than the demographics only and modified Oxford only models (P<0.05 for all). The optimized Oxford model had greater prediction accuracy than the demographics+modified Oxford model, but similar rates of outlier predictions (P=0.903). No differences in mean prediction accuracy or rate of outlier predictions were observed between the optimized Oxford and the demographics+GP model (P>0.05).

CONCLUSION

High precision in skeletal maturity estimation can be achieved by using chronological age, sex, and 5 hip radiographic parameters.

CLINICAL RELEVANCE

We have developed a skeletal maturity system that utilizes anteroposterior hip radiographs and performs as accurately as GP.

背景

目前还没有通过髋关节 X 光片来评估骨骼成熟度的能力，但这种方法可能对脊柱侧凸、股骨头骨骺滑脱和下肢畸形的治疗有用。我们试图开发一种快速、准确且可重复的方法。

方法

我们评估了 3 年前至与最终身高 90%相关的骨骼年龄后 2 年内的 14 项髋关节影像学参数，这是一种经过验证的骨骼成熟度定义，与身高增长高峰期的时间相关。同时还获得了 Greulich 和 Pyle（GP）左手骨龄作为比较。使用逐步线性回归和广义估计方程分析来分离关键的髋关节和人口统计学参数，创建“优化牛津”骨骼成熟度系统。评估并比较了优化牛津系统预测从 90%最终身高起的年数的准确性，与仅基于人口统计学的系统、改良牛津系统、人口统计学+改良牛津系统和人口统计学+GP 系统进行比较。

结果

共纳入了 41 名女孩（年龄范围：7 至 15 岁）和 38 名男孩（年龄范围：9 至 17 岁）的 284 张髋关节 X 光片。经过多变量分析，原始的 14 个髋关节影像学参数中有 5 个仍然具有显著意义。优化牛津模型的预测具有更高的准确性和更少的异常值预测（预测值比实际从 90%最终身高起的年数相差超过 1 年），优于仅基于人口统计学和改良牛津系统（所有 P<0.05）。优化牛津模型的预测准确性优于人口统计学+改良牛津模型，但异常值预测的比例相似（P=0.903）。优化牛津模型与人口统计学+GP 模型在平均预测准确性或异常值预测比例方面没有差异（P>0.05）。