简化骨龄评分系统对女性特发性脊柱侧凸患者生长潜能的预测价值

The value of simplified skeletal maturity scoring system in the prediction of growth potential in female idiopathic scoliosis

中文关键词:  特发性脊柱侧凸  简化骨龄评分  身高纵向生长速率

英文关键词:Idiopathic scoliosis  Simplified skeletal maturity scoring system  Height velocity

中文摘要:

  【摘要】 目的：分析简化骨龄评分系统（simplified skeletal maturity scoring system，SSMS）与其他骨骼发育成熟度评估指标的相关性，探讨其对特发性脊柱侧凸（idiopathic scoliosis，IS）患者生长潜能的预测价值。方法：回顾性分析于我院门诊行规范支具治疗的50例女性IS患者，其中胸主弯32例，胸腰弯18例，随访时间3.1±0.9年（2.0~5.6年）。于患者每次随访时拍摄的左手掌正位X线片上进行SSMS评分、指骨骨龄（digital skeletal age，DSA）评分和尺桡掌骨（radius，ulna，and small bones，RUS）骨龄评分，随访间隔为4~6个月。记录患者每次随访时的年龄、月经情况及纵向身高等资料，计算患者每次随访时的身高纵向生长速率（height velocity，HV）。采用Spearman相关系数分析SSMS评分与DSA评分及RUS评分间的相关性。结果：患者初诊年龄为10.8±1.4岁（8.0~12.9岁），月经初潮年龄为12.5±2.2岁（10.1~14.8岁），初诊SSMS评分为2.0±0.9分（1~3分），初诊DSA评分为370.1±55.7分（240~487分），初诊RUS评分为582.3±88.6分（419~699分）。随访中患者身高纵向生长速率峰值（peak height velocity，PHV）为7.6±1.6cm/年（5.3~10.0cm/年），PHV的年龄为12.1±1.1岁（10.5~13.8岁）。26%（13/50）的患者在SSMS评分2分时达到PHV，52%（26/50）的患者在SSMS评分3分时达到PHV，16%（8/50）的患者在SSMS评分4时分达到PHV，4%（2/50）的患者在SSMS评分5分时达到PHV，2%（1/50）的患者在SSMS评分6分时达到PHV。Spearman相关性分析表明，每次随访时的SSMS评分与DSA评分及RUS评分均具有良好的相关性（r=0.958和0.967，P<0.001）。结论：SSMS评分2~4分预示着女性IS患者具有较高的生长潜能和纵向生长速率。SSMS评分是一种易于掌握且对女性IS患者生长潜能具有较高预测能力的骨龄评分系统。

英文摘要:

  【Abstract】 Objectives: To investigate the correlation between simplified skeletal maturity scoring system (SSMS) and other maturity indicators, and to evaluate its predictive value for growth potential in idiopathic scoliosis(IS) girls. Methods: Fifty female IS patients undergoing standardized bracing treatment were recruited in our study, including 32 major thoracic curves and 18 thoracolumbar curves. The average follow-up period was 3.1±0.9(2.0-5.6) years. SSMS, digital skeletal age(DSA) and radius, ulna, and small bones(RUS) scores were measured on posteroanterior radiographs of left hand at each visit, and the follow-up interval was 4-6 months. Moreover, the chronologic age, stage of menarche, standing height at each visit were recorded, and the height velocity(HV) was calculated at each follow-up. The Spearman coefficients were used to investigate the correlations of SSMS with DSA scores and RUS scores. Results: The average chronologic age, menarche age, SSMS stages, DSA scores and RUS scores at initial visit were 10.8±1.4(8.0-12.9) years, 12.5±2.2(10.1-14.8) years, 2.0±0.9(1-3), 370.1±55.7(240-487), 582.3±88.6(419-699), respectively. During the follow-up, the average peak height velocity(PHV) was 7.6±1.6(5.3-10.0)cm/years and the average age was 12.1±1.1 (10.5-13.8) years. 26%(13/50) of the IS patients in our study attained their PHV in SSMS 2, 52%(26/50) in SSMS 3, 16%(8/50) in SSMS 4, 4%(2/50) in SSMS 5, and 2%(1/50) in SSMS 6. Significant correlations of SSMS with DSA scores and RUS scores at each visit were found by the Spearman correlation analysis(r=0.958 and 0.967, P<0.001). Conclusions: The SSMS 2-4 suggests high growth potential and high height velocity in IS girls. Hence, SSMS can serve as a reliable predictor for growth potential in braced female IS patients.