中国人手腕骨发育标准—中华05 I.TW_3-CRUS、TW_3-C腕骨和RUS-CHN方法

The Skeletal Development Standards of Hand and Wrist for Chinese Children—China 05 I. TW_3-C RUS, TW_3-C Carpal, and RUS-CHN Methods

目的:适应20年来中国儿童出现的长期快速的生长发育趋势,修订中国人手腕骨发育标准。方法:标准化样本为0～20岁的17401名(男8685名,女8716名)城市汉族正常青少儿。由一名评价者使用TW3方法阅读所有X线片。另外,在第一掌骨、近节指骨和中节指骨的第4、5、6、7等级,远节指骨的5、6、7等级,以及桡骨的第5、6等级和尺骨第5等级内选择新的骨成熟度指征,将每个等级分为两个骨发育等级;同时,根据桡骨、尺骨的融合程度将融合过程划分为4个阶段。使用分类特征计分算法计算骨发育等级得分。这种新的骨龄评价方法称为RUS-CHN法。结果:以百分位数法分别制订了TW3-CRUS、TW3-C腕骨、RUS-CHN骨龄标准,称为《中国人手腕骨发育标准—中华05》。经在1～19岁2438名(男1301名,女1137名)对象中应用检验,各年龄组TW3-CRUS、TW3-C腕骨、RUS-CHN骨龄与生活年龄的差值大都在0.0～0.3岁之间。结论:《中国人手腕骨发育标准—中华05》适用于我国当代儿童。

Objective The existing standards of skeletal development for Chinese were revised in this study due to the accelerated growth and development of Chinese children in the past 20 years. Methods Seventeen thousand and four hundred and one （17,401） healthy children of Han nationality （8,685 boys, 8,716 girls）, aged 0 - 20 years, from cities of Shanghai, Guangzhou, Wenzhou, Dalian and Shijiazhuang were served as the sample for standardization. The radiographs were evaluated by a single observer using TW3 method. Furthermore, the new skeletal maturity events were chosen in 4, 5, 6, 7 stages of first metacarpal, proximal and middle phalanges, as well as in 5, 7 stages of radius and 5 stage of ulna in accordance to TW3 - RUS. As a result, each stage was divided into two new stages. The fusion stages of radius and ulna were divided to 4 phases. The skeletal maturity scoring was computed by ＂scaling of categorized attributes＂ to minimize the overall disagreement between the different bones totaled over the standardizing sample. The new method is called RUS - CHN. The means and standard deviations of maturity score transformed by logarithm in each age group were calculated, and were fitted by quadratic and linear functions of age, respectively. Results The percentile standards of TW3 - C RUS, TW3 - C Carpal, RUS - CHN skeletal maturity scores were established. The revised standards are designated as ＂The Standards of Skeletal Maturity of Hand and Wrist for Chinese of Han Nationality - China 05＂. Ages of the complete maturity of TW3 - C RUS, TW3 - C Carpal and RUS - CHN standards are 16, 13.5 and 18 years in boys and 15, 11.5 and 17 years in girls, respectively. In the verified sample of 2,438 children （1,301 boys, 1,137 girls）, aged 1 - 19 years, the differences between skeletal age and chronological age of all age groups were mostly 0.0 - 0.3 year in TW3 - C RUS, TW3 - C Carpal and RUS- CHN skeletal maturity standards. Conclusion ＂The Standards of Skeletal Maturity of Hand and Wrist for Chinese of Han Nationality- China 05＂ are applicable to contemporary Chinese children.