Woodhams William, Shaw K Aaron, O'Sullivan Michael, Jo Chanhee, Herring J Anthony
Department of Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, MO.
Children's Health Ireland at Temple Street, Dublin, Ireland.
J Pediatr Orthop. 2025 Sep 1;45(8):481-484. doi: 10.1097/BPO.0000000000003001. Epub 2025 Apr 28.
Legg-Calve-Perthes disease (LCPD) outcomes are largely determined by their age and maturity at onset. In LCPD, there is a known association with delayed skeletal maturity of up to 1.9 years in affected children based on maturity assessment with the Greulich and Pyle (GP) maturity atlas. The GP atlas is the standard for assessing bone age but requires obtaining a separate radiograph of the hand. A new methodology for assessing skeletal maturation in comparison to the GP bone age in children with LCPD was sought.
A retrospective review of a prospective, multicenter study of patients with LCPD treated from 1984 to 1991 and followed to skeletal maturity was performed. Patients were included if they had LCPD diagnosed on anteroposterior pelvis radiographs that included the contralateral hip who had bone age radiographs obtained at the time of presentation. Patients were excluded if they presented with bilateral LCPD, the contralateral hip was not visualized on their presenting radiographs, they lacked bone age radiographs at the time of presentation, or they presented outside the range for the Optimized Oxford system. A formula using the greater trochanteric height to femoral head diameter ratio and patient sex (GT+ Sex) for predicting GP bone age was developed. The GP and GT+ Sex bone ages were compared with the chronologic age (CA) to determine the mean discrepancy.
Seventy-one patients were included (mean 9.5 ± 1.2 y at presentation, 42.2% females). Skeletal maturity assessment by the GP bone age method demonstrated a mean discrepancy of 1.4 years younger than CA (95% CI: 1.01-1.76 y). GT+ Sex bone age assessment demonstrated a mean discrepancy of 1.4 years younger than CA (95% CI: 1.03-1.75 y). The GP bone age was a mean of 0.00 years different than the GT+ Sex assessment bone age (95% CI: -0.3 to 0.3 y). The GT+ Sex assessment bone age correlated significantly with GP bone age ( R =0.89, P <0.0001). Male patients had a significantly younger GP bone age relative to CA compared with female patients (1.8 vs. 0.86 y, P = 0.02); however, there were fewer sex differences in the GT+ Sex assessment bone age relative to CA (male, 1.77 y younger vs. 1.12 y younger; P = 0.01).
The GT+ Sex skeletal maturity assessment system in children with LCPD significantly correlated with the GP bone age system when compared. The GT+ Sex assessment may provide an assessment of the true bone age in LCPD patients without the need for hand radiographic imaging studies.
Level III-retrospective review and analysis.
莱-卡-佩病（LCPD）的预后很大程度上取决于发病时的年龄和成熟度。在LCPD中，根据格吕利希和派尔（GP）成熟度图谱进行成熟度评估，已知受影响儿童的骨骼成熟延迟可达1.9年。GP图谱是评估骨龄的标准，但需要单独拍摄手部X光片。人们寻求一种与LCPD患儿的GP骨龄相比评估骨骼成熟度的新方法。
对1984年至1991年接受治疗并随访至骨骼成熟的LCPD患者的前瞻性多中心研究进行回顾性分析。如果患者在前后位骨盆X光片上被诊断为LCPD，且该X光片包括对侧髋关节，并且在就诊时拍摄了骨龄X光片，则纳入研究。如果患者表现为双侧LCPD、就诊时的X光片上未显示对侧髋关节、就诊时缺乏骨龄X光片或超出优化牛津系统范围，则排除在外。开发了一种使用大转子高度与股骨头直径之比和患者性别（GT + 性别）来预测GP骨龄的公式。将GP和GT + 性别骨龄与实际年龄（CA）进行比较，以确定平均差异。
纳入71例患者（就诊时平均年龄9.5±1.2岁，42.2%为女性）。通过GP骨龄方法进行的骨骼成熟度评估显示，平均比实际年龄小1.4岁（95%可信区间：1.01 - 1.76岁）。GT + 性别骨龄评估显示，平均比实际年龄小1.4岁（95%可信区间：1.03 - 1.75岁）。GP骨龄与GT + 性别评估骨龄的平均差异为0.00岁（95%可信区间： - 0.3至0.3岁）。GT + 性别评估骨龄与GP骨龄显著相关（R = 0.89，P < 0.0001）。与女性患者相比，男性患者的GP骨龄相对于实际年龄明显更小（1.8岁对0.86岁，P = 0.02）；然而，GT + 性别评估骨龄相对于实际年龄的性别差异较小（男性小1.77岁对女性小1.12岁；P = 0.01）。
与GP骨龄系统相比，LCPD患儿的GT + 性别骨骼成熟度评估系统与之显著相关。GT + 性别评估可能无需手部X光成像研究就能评估LCPD患者的真实骨龄。
III级——回顾性分析。
