Department of Orthopaedics, University of Pécs, Medical School, Pécs, Hungary.
Department of Primary Health Care, University of Pécs, Medical School, Pécs, Hungary.
PLoS One. 2022 May 6;17(5):e0267668. doi: 10.1371/journal.pone.0267668. eCollection 2022.
Hand-wrist bone age assessment methods are not possible on typical EOS 2D/3D images without body position modifications that may affect spinal position. We aimed to identify and assess lesser known bone age assessment alternatives that may be applied retrospectively and without the need for extra imaging.
After review of 2857 articles, nine bone age methods were selected and applied retrospectively in pilot study (thirteen individuals), followed by evaluation of EOS images of 934 4-24-year-olds. Difficulty of assessment and time taken were recorded, and reliability calculated.
Five methods proved promising after pilot study. Risser 'plus' could be applied with no difficulty in 89.5% of scans (836/934) followed by the Oxford hip method (78.6%, 734/934), cervical (79.0%, 738/934), calcaneus (70.8%, 669/934) and the knee (68.2%, 667/934). Calcaneus and cervical methods proved to be fastest at 17.7s (95% confidence interval, 16.0s to 19.38s & 26.5s (95% CI, 22.16s to 30.75s), respectively, with Oxford hip the slowest at 82.0 s (95% CI, 76.12 to 87.88s). Difficulties included: regions lying outside of the image-assessment was difficult or impossible in upper cervical vertebrae (46/934 images 4.9%) and calcaneus methods (144/934 images, 15.4%); position: lower step length was associated with difficult lateral knee assessment & head/hand position with cervical evaluation; and resolution: in the higher stages of the hip, calcaneal and knee methods.
Hip, iliac crest and cervical regions can be assessed on the majority of EOS scans and may be useful for retrospective application. Calcaneus evaluation is a simple and rapidly applicable method that may be appropriate if consideration is given to include full imaging of the foot.
在不改变可能影响脊柱位置的体位的情况下，普通 EOS 2D/3D 图像无法进行手腕骨龄评估。我们旨在确定和评估其他鲜为人知的骨龄评估方法，这些方法可以回溯性应用，而无需额外的成像。
在回顾了 2857 篇文章后，选择了 9 种骨龄评估方法，并在试点研究（13 人）中进行了回溯性应用，然后评估了 934 名 4-24 岁儿童的 EOS 图像。记录了评估的难度和所花费的时间，并计算了可靠性。
五项方法在试点研究后具有潜力。Risser'plus'可在 89.5%（934/934）的扫描中轻松应用，其次是牛津髋关节方法（78.6%，734/934）、颈椎（79.0%，738/934）、跟骨（70.8%，669/934）和膝关节（68.2%，667/934）。跟骨和颈椎方法的速度最快，分别为 17.7 秒（95%置信区间为 16.0 秒至 19.38 秒和 26.5 秒（95%置信区间为 22.16 秒至 30.75 秒），而牛津髋关节方法最慢，为 82.0 秒（95%置信区间为 76.12 秒至 87.88 秒）。困难包括：上颈椎（46/934 张图像，4.9%）和跟骨方法（144/934 张图像，15.4%）的评估区域超出图像范围；位置：较低的步长与外侧膝关节评估困难有关，头/手位置与颈椎评估有关；分辨率：在髋关节、跟骨和膝关节的较高阶段。
髋关节、髂嵴和颈椎区域可在大多数 EOS 扫描中进行评估，并且可能适用于回溯性应用。跟骨评估是一种简单且快速适用的方法，如果考虑包括足部的完整成像，可能是合适的。
