指骨骨龄对特发性脊柱侧凸患者脊柱生长潜能评估的组织学研究

Digital skeletal age and histological evaluation for residual spine growth potential in idiopathic scoliosis

目的探讨特发性脊柱侧凸（IS）患者指骨骨龄（DSA）对生长潜能评估的可靠性。方法于28例IS患者前路手术时采集其椎体上、下生长板标本，行HE染色，光镜下行组织学观察并进行组织学分级（HG）。患者左手中指正位X线片确定DSA分期。对患者HG、DSA分期、月经状态和社会学年龄进行相关性分析。结果28例IS患者DSA分期与椎体生长板HG之间存在显著负相关（r=-0．541，P=0．003）。在DSAⅡ期和DSAⅢ期患者之间，生长潜能差异具有统计学意义（P=0．014）。7例DSAⅢ期患者椎体生长板组织学有Ⅱ度生长活性。DSAⅢ期患者椎体生长板HG与月经状态（初潮至手术的时间）存在显著负相关（r=-0．591，P=0．006）。结论DSA分期可能为临床评估IS患者脊柱生长潜能的方便易行指标，但必须结合患者的月经状态和社会学龄才能正确评估IS患者的脊柱生长潜能。

Objective To ascertain the correlation between histological grades （HGs） of vertebral growth plates and Risser grades in idiopathic scoliosis （IS） patients; to identify whether digital skeletal age （DSA） is a reliable indicator for accurate evaluation of the spinal residual growth potential. Methods Twenty eight Chinese female patients were available for this study. Superior and inferior growth plates were obtained at each level when anterior approach surgeries were performed. Histological examinations were conducted after the specimens were processed. The patients were evaluated by DSA stages in this study. Correlations between histological grades, menarchal status, and chronological age were analyzed. Results There was a negative correlation between the following： HGs and DSA stages in 28 cases （r = -0. 541, P = 0. 003）, and HGs and menarchal status in patients in DSA stage Ⅲ （r = -0. 591, P =0. 006）. Statistical significance of growth activity of growth plates was found between patients in DSA-stage Ⅱ and those in DSA-stage Ⅲ （P=0.014）. Conclusions DSA may be a reliable indicator for predicting the spinal residual growth potential in IS patients, but it should be correlated with menarchal status and chronological ages.