三种骨龄评价方法在3~17岁儿童临床应用中的 一致性比较研究

摘要/Abstract

摘要：

目的：评价Greulich-Pyle 图谱法（GP）、中国人手腕骨发育标准-CHN法（CHN）和中国人手腕标准-中华05法（TW3-C RUS）测得的骨龄是否会影响临床医生对儿童骨成熟水平的判断。方法：纳入因身材矮小或提前发育或怀疑生长发育问题有必要行X线片评估的3~17岁儿童左手正位X线骨龄片。排除患遗传代谢性、骨软骨发育障碍性疾病的儿童，排除接受过生长激素等治疗的儿童。1名经过骨龄片评估培训的研究生依序对每张X线骨龄片用上述3种方法分别评价，采用Bland-Altman法构建一致性限。结果：567例左手正位X线片进入分析，男童269例，女童298例，男、女童各分3~4、~6、~8、~10、~12、~14和~17年龄组，每组17~78例。男103例和女142例达到青春期发育标准。男、女童所有年龄组测得的骨龄CHN法＞ GP法和TW3-C RUS法；男、女童中除3个年龄组外，余11个年龄组测得骨龄TW3-C RUS法均＜GP法。男、女童的所有年龄组3种方法评价的最大骨龄与最小骨龄的差值随年龄增加而增大。鉴于TW3-C RUS评价男童最大骨龄为16岁，女童最大骨龄为15岁，去除TW3-C RUS法男童≥16岁（18例）和女童≥15岁（34例）的骨龄片，515例左手正位的X线片(男251例，女264例)进入3种方法一致性限分析。男童3~4岁骨龄和~6岁骨龄TW3-C RUS法与GP法一致性良好，女童3~4岁骨龄CHN法与TW3-C RUS法、~8岁骨龄TW3-C RUS法与GP法一致性良好，女童未发育组TW3-C RUS法与GP法一致性良好，余男、女童不同骨龄和发育情况3种骨龄测量法一致性差。结论：3种骨龄测量方法得出的骨龄结果不能相互替代，临床应用时应明确骨龄测评的方法。

Abstract:

Objective: To evaluate whether the skeletal age assessed by Greulich-Pyle (GP), Chinese human wrist development standard CHN (CHN) and Chinese Wrist Standard - Chinese 05 (TW3-C RUS) will affect clinicians' judgment of skeletal maturity. Methods: Aged 3 to 17 children's left anteroposterior X-ray films were included for short stature, early puberty or suspected growth and development issues, and those of the children who suffering from metabolic genetic, growth disorders, osteochondral disease and had received growth hormone treatment were excluded. Each of the X-ray films was evaluated in three methods by a graduate student who had been trained in skeletal age assessment. Constructing limits of agreement were made by Bland-Altman Method.Results: 567 cases (269 boys, 298 girls) of left anteroposterior radiographs were analyzed. Each gender divided into 7 age groups, the numbers of those groups up to 78 cases, at least 17 cases. 103 boys, 142 girls were in puberty. The skeletal age of CHN method was higher than that of GP method in all age groups, and it was also higher than that of TW3-C RUS method. Except for three age groups, the skeletal age of TW3-C RUS was less than that of GP. The difference between the maximum and the minimum skeletal age of the three methods in all age groups of boys and girls increased with age. In view of the TW3-C RUS upper limit of evaluation , 16-year-old boy, 15-year-old girl, those radiographs assessed by the TW3-C RUS method for boys over or equal 16 years old (18 cases) and girls over or equal 15 years old (34 cases) were excluded. Finally, 515 radiographs (251 boys, 264 girls) entered the consistency limits analysis. In boys, the consistency was good between TW3-C RUS method and GP method, in the 3~4 years' skeletal age group and ~6 years' skeletal age group. In the girls, between CHN method and TW3-C RUS method, in 3~4 years' skeletal age group the consistency was good; Between TW3-C RUS method and GP method, ~8 years' skeletal age group, was with good consistency. There was good consistency between TW3-C RUS and GP in girls without puberty development group, and the consistency of skeletal age and puberty development of the rest group in boys and girls was poor.Conclusion: The skeletal age results obtained by the three skeletal age measurement methods cannot be substituted for each other. The method of evaluating skeletal age should be clear and definite in clinical applications.

张鹏飞李辉. 三种骨龄评价方法在3~17岁儿童临床应用中的一致性比较研究[J]. 中国循证儿科杂志, 2017, 12(4): 263-267.

ZHANG Peng-fei, LI Hui . Comparison of the consistency of three skeletal age methods in 3 to 17 years old children[J]. Chinese Journal of Evidence -Based Pediatric, 2017, 12(4): 263-267.