Division of Orthopedic Surgery, Oslo University Hospital.
Institute of Clinical Medicine.
J Pediatr Orthop. 2023 Jul 1;43(6):386-391. doi: 10.1097/BPO.0000000000002397. Epub 2023 Mar 20.
Bone age (BA) has been shown to be superior to chronological age (CA) when predicting remaining growth. However, it is not known whether the calculations are more accurate when BA is assessed by the Greulich and Pyle (GP) or the Sauvegrain (SG) methods. The aim of our study was to identify the method which gives an estimate closest to actual growth in the lower extremities.
Leg length radiographs, hand radiographs, and elbow radiographs were simultaneously obtained during the adolescent growth spurt (10 to 16 years) in 52 children treated for LLD, with radiographic follow-up of segmental length (femur, tibia, and foot) until skeletal maturity, were randomly selected from a local institutional register. BA, according to GP and SG, were manually rated, and BA based on the GP method was additionally assessed by the automated BoneXpert (BX) method. The remaining growth was calculated based on the White-Menelaus method for both BA methods (GP, SG), the combination of the 2 methods, GP by BX, CA, and the combination of CA and GP by BX. Estimated growth was compared with the actual growth in the distal femur and proximal tibia from the time of BA determination until skeletal maturity.
For all included methods, the average calculated remaining growth was higher compared with the actual growth. The mean absolute difference between calculated remaining growth and actual growth in the femur and tibia was lowest using GP by BX [0.66 cm (SD 0.51 cm) and 0.43 cm (SD 0.34 cm)] and highest using CA [1.02 (SD 0.72) and 0.67 (SD 0.46)]. It was a significant association between calculated growth and the difference between actual and calculated growth for the SG method ( P =<0.001).
During the adolescent growth spurt, the GP method compared with the SG method and CA gives the most accurate estimate of remaining growth around the knee according to our results.
In calculations of remaining growth around the knee, BA assessment by the GP atlas or BX method should be used as the parameter of biological maturity.
骨龄（BA）在预测剩余生长方面优于实际年龄（CA）。然而，目前尚不清楚在评估 BA 时，使用 Greulich 和 Pyle（GP）或 Sauvegrain（SG）方法的计算结果是否更准确。我们的研究目的是确定哪种方法可以最准确地估计下肢的实际生长。
在青春期生长突增期间（10 至 16 岁），我们随机从当地机构登记处选择了 52 名接受下肢不等长（LLD）治疗的儿童，同时获得了下肢长度的 X 光片、手部 X 光片和肘部 X 光片，进行了骨骼成熟的节段长度（股骨、胫骨和足部）的放射学随访。根据 GP 和 SG 手动评估 BA，并且通过自动 BoneXpert（BX）方法评估 GP 方法的 BA。根据 White-Menelaus 方法，分别基于 GP 和 SG 两种 BA 方法、两种方法的组合、GP 与 BX 的组合、CA 以及 CA 与 BX 的组合计算剩余生长。将估计的生长与从 BA 确定到骨骼成熟期间远端股骨和近端胫骨的实际生长进行比较。
对于所有纳入的方法，计算出的剩余生长平均值均高于实际生长。股骨和胫骨中计算出的剩余生长与实际生长之间的平均绝对差值最低的是 GP 与 BX（0.66cm[0.51cm]和 0.43cm[0.34cm]），最高的是 CA（1.02cm[0.72cm]和 0.67cm[0.46cm]）。SG 方法中，计算出的生长与实际生长和计算出的生长之间的差值之间存在显著相关性（P<0.001）。
根据我们的结果，在青春期生长突增期间，与 SG 方法和 CA 相比，GP 方法可以更准确地估计膝关节周围的剩余生长。
在膝关节周围剩余生长的计算中，应使用 GP 图谱或 BX 方法评估 BA 作为生物学成熟度的参数。
