在青少年特发性脊柱侧凸患者中，Risser 征与简化骨骼成熟度评分/拇指骨化复合指数的骨骼成熟度评估存在显著差异。
Substantial mismatch of skeletal maturity assessment between Risser sign and Simplified Skeletal Maturity Scale/Thumb Ossification Composite Index in patients with adolescent idiopathic scoliosis.
机构信息
Department of Orthopaedic Surgery, NHO Utsunoimya Hospital, 2160, Shimo-okamoto, Utsunomiya, Tochigi, 329-1193, Japan.
Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan.
出版信息
Spine Deform. 2023 Jul;11(4):853-860. doi: 10.1007/s43390-023-00680-3. Epub 2023 Apr 1.
BACKGROUND
Recently, hand skeletal maturity systems such as the Simplified Skeletal Maturity Scale (SSMS) or Thumb Ossification Composite Index (TOCI) have been introduced to attempt to prospectively predict the occurrence of peak height velocity (PHV) in adolescents. This study aims to compare the frequency of the mismatch in estimation of HV between Risser sign (RS) and SSMS/TOCI stages in adolescent idiopathic scoliosis (AIS) patients.
METHODS
One hundred thirty-three female patients with AIS were included. The mean age of the patients was 13.1 years. A whole spine and hand X-rays were obtained to establish skeletal maturity stage according to RS, SSMS, and TOCI systems. A mismatch resulting in overestimation (MOE) with RS compared to SSMS/TOCI was defined as the combination of RS 3-4/SSMS 3-5 or RS 3-4/TOCI 4-6, whereas a mismatch resulting in underestimation (MUE) with RS and SSMS/TOCI was defined as RS 0-1/SSMS 6-8 or RS 0-1/TOCI 7-8. Height velocity (HV) was compared between MOE/non-MOE and MUE/non-MUE groups.
RESULTS
Between RS and SSMS, the rates of the MOE and MUE groups were 4.3% and 1.7%, respectively. Between RS and TOCI, rates were 2.8% and 1.7%, respectively. With the combination of RS and SSMS stages, an estimate of HV of 5.6 cm/year in the MOE group was significantly larger than that of 2.7 cm/year in the non-MOE group, and 3.7 cm/year in the MUE group was significantly smaller than 6.9 cm/year in the non-MUE group. Likewise, with the combination of RS and TOCI stages, an estimate of HV of 5.8 cm/year in the MOE group was significantly greater that of 2.7 cm/year in the non-MOE group, and 3.7 cm/year in the MUE group was significantly smaller than 6.9 cm/year in the non-MUE group.
CONCLUSIONS
These findings support the use of SSMS/TOCI as the standard for assessing HV and skeletal maturity in patients with AIS.
背景
最近，手骨成熟度系统，如简化骨骼成熟度评分（SSMS）或拇指骨化复合指数（TOCI），已被引入，以尝试预测青少年的高峰生长速度（PHV）的发生。本研究旨在比较脊柱侧凸特发性青少年患者中 Risser 征（RS）和 SSMS/TOCI 分期估计 HV 时的不匹配频率。
方法
纳入 133 例女性 AIS 患者。患者的平均年龄为 13.1 岁。获得全脊柱和手部 X 线片，根据 RS、SSMS 和 TOCI 系统确定骨骼成熟度分期。与 RS 相比，SSMS/TOCI 导致高估的不匹配（MOE）定义为 RS 3-4/SSMS 3-5 或 RS 3-4/TOCI 4-6 的组合，而 RS 和 SSMS/TOCI 导致低估的不匹配（MUE）定义为 RS 0-1/SSMS 6-8 或 RS 0-1/TOCI 7-8。比较 MOE/非 MOE 和 MUE/非 MUE 组之间的 HV。
结果
RS 与 SSMS 之间，MOE 和 MUE 组的发生率分别为 4.3%和 1.7%。RS 与 TOCI 之间，发生率分别为 2.8%和 1.7%。结合 RS 和 SSMS 分期，MOE 组的 HV 估计值为 5.6cm/年，明显大于非 MOE 组的 2.7cm/年，MUE 组的 3.7cm/年明显小于非 MUE 组的 6.9cm/年。同样，结合 RS 和 TOCI 分期，MOE 组的 HV 估计值为 5.8cm/年，明显大于非 MOE 组的 2.7cm/年，MUE 组的 3.7cm/年明显小于非 MUE 组的 6.9cm/年。
结论
这些发现支持使用 SSMS/TOCI 作为评估 AIS 患者 HV 和骨骼成熟度的标准。
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