基于关键 AP 膝关节 X 线参数的分段线性建模来评估骨骼成熟度。

Estimating Skeletal Maturity by Segmented Linear Modeling of Key AP Knee Radiographic Parameters.

机构信息

Case Western Reserve University School of Medicine.

Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine.

出版信息

J Pediatr Orthop. 2022 Mar 1;42(3):169-173. doi: 10.1097/BPO.0000000000001988.

DOI:10.1097/BPO.0000000000001988

PMID:35138299

Abstract

BACKGROUND

The recently described Modified Fels knee system allows for accurate skeletal maturity estimation using a single anteroposterior knee radiograph but requires evaluation of 7 parameters. A faster method may have clinical utility in the outpatient setting.

METHODS

Seven anteroposterior knee radiographic parameters associated with 90% of the final height (an enhanced skeletal maturity standard compared with peak height velocity) were analyzed in 78 children. Segmented linear regression and generalized estimating equation analyses were used to identify the subsets of parameters most important for accurate skeletal maturity estimation for different patient demographics and parameter scores. This process produced abbreviated skeletal maturity systems, which include fewer parameters and are quicker to use. The accuracy of the resulting abbreviated skeletal maturity systems was evaluated and compared with the full 7-parameter Modified Fels knee system and with the Greulich and Pyle (GP) left-hand bone age.

RESULTS

A total of 326 left knee radiographs from 41 girls (range, 7 to 15 y) and 37 boys (range, 9 to 17 y) were included. Models generated by segmented regression and generalized estimating equation analysis required fewer parameters (range, 1 to 5 parameters) than the full Modified Fels knee system (7 parameters). Skeletal age estimates produced by segmented regression models were more accurate than GP (P<0.05) and not significantly different from the full Modified Fels system (P>0.05). The percentage of outlier estimations (estimations >1 y off from actual skeletal age) made by segmented regression models was not significantly different from GP (P>0.05) or the Modified Fels knee system (P>0.05).

CONCLUSION

An abbreviated version of the Modified Fels knee system estimates skeletal maturity more accurately than the GP system with just 2 to 3 radiographic knee parameters.

CLINICAL RELEVANCE

The abbreviated Modified Fels knee system may allow for rapid skeletal age estimation (~30 s) appropriate for routine outpatient practice.

摘要

背景

最近描述的改良 Fels 膝关节系统允许使用单个前后位膝关节 X 光片准确估计骨骼成熟度，但需要评估 7 个参数。在门诊环境中，更快的方法可能具有临床实用性。

方法

对 78 名儿童的 7 个前后位膝关节 X 光片相关参数进行分析，这些参数与 90%的最终身高（与峰值身高速度相比，是一种增强的骨骼成熟度标准）相关。使用分段线性回归和广义估计方程分析来确定不同患者人口统计学和参数评分下对准确骨骼成熟度估计最重要的参数子集。这个过程产生了简化的骨骼成熟度系统，包括更少的参数，并且使用起来更快。评估并比较了简化骨骼成熟度系统的准确性，与完整的 7 个参数改良 Fels 膝关节系统和 Greulich 和 Pyle（GP）左手骨龄系统。

结果

共纳入 41 名女孩（年龄 7 至 15 岁）和 37 名男孩（年龄 9 至 17 岁）的 326 张左膝关节 X 光片。分段回归和广义估计方程分析生成的模型所需的参数少于完整的改良 Fels 膝关节系统（7 个参数）（范围 1 至 5 个参数）。分段回归模型产生的骨骼年龄估计比 GP（P<0.05）更准确，与完整的改良 Fels 系统无显著差异（P>0.05）。分段回归模型的离群估计（估计与实际骨骼年龄相差 1 年以上）的百分比与 GP（P>0.05）或改良 Fels 膝关节系统（P>0.05）无显著差异。