尺桡骨远端骨龄评分系统在特发性脊柱侧凸患者生长潜能及侧凸进展评估中的价值

Distal radius and ulna classification system as a good predictor for growth potential and curve progression in idiopathic scoliosis

目的 ：探讨尺桡骨远端（distal radius and ulna,DRU）骨龄评分系统与其他成熟度指标的相关性,并评估其在特发性脊柱侧凸（idiopathic scoliosis,IS）患儿生长潜能和侧凸进展中的预测价值。方法：选取长期定期随访的36例女性IS患儿为观察对象,所有患儿均行标准化支具治疗,随访间隔为3～6个月直到停止支具治疗。每次随访时记录并测量如下参数：患者实足年龄、身高、主弯Cobb角、脊柱长度、Risser征、DSA（digital skeletal age）评分和DRU评分。据此计算患儿每次随访时的身高生长速率（height velocity,HV）、Cobb角进展速率（angle velocity,AV）和脊柱生长速率（spinal length velocity,SLV）。分析不同DRU骨龄评分时的HV、SLV及AV值并比较AV〉5°/年的发生率,评估其对IS患儿侧凸进展的预测价值。结果：36例患儿初诊时年龄为10.8±1.2岁,桡骨远端骨龄评分为R6.3±1.2,尺骨远端骨龄评分为U4.6±1.5。桡骨远端骨龄评分介于R7～R9之间和尺骨远端骨龄评分介于U5～U7之间均预示较高的HV、SLV和AV,其中AV〉5°/年的发生率较桡骨远端骨龄评分R9和尺骨远端骨龄评分U7明显升高（P〈0.05）。桡骨远端和尺骨远端的骨龄评分具有良好相关性（P〈0.001）。结论：桡骨远端骨龄评分介于R7～R9之间和尺骨远端骨龄评分介于U5～U7之间均预示IS患者具有较高的身高生长速率、脊柱生长速率及侧凸Cobb角进展速率。DRU骨龄评分系统是一种良好的评估IS患儿生长潜能及侧凸进展风险的指标。

Objectives： To correlate the distal radius and ulna stages（DRU） with several growth potential indicators, and to evaluate the predictive value of DRU system for curve progression in a group of braced idiopathic scoliosis（IS） patients. Methods： This was a consecutive longitudinal study on physically immature IS girls, who had received standardized bracing treatment and regular follow-up every 3-6 months until brace weaning. The following data of each follow-up were collected： chronologic age, height, Cobb angle, spinal length, Risser sign, digital skeletal age（DSA） scores and DRU scores. The height velocity（HV）, angle velocity（AV） and spinal length velocity（SLV） of each follow-up were calculated. The values of HV, SLV and AV were analyzed and the rates of AV 5° /y were compared among different DRU stages. Results： Thirty-six braced IS girls with single thoracic or thoracolumbar curves were reviewed. The average age at the first visit was 10.8±1.2 years. The average values of initial DRU scores were R6.3 ±1.2 and U4.6 ±1.5 for radius and ulna, respectively. Both R7-R9 and U5-U7 indicated high HV, high SLV and high AV. The rates of AV5°/y were significantly higher in patients within R7-R9 and U5-U7（P〈0.05）. Moreover, the scores of distal radius and distal ulna were significantly correlated（P〈0.001）. Conclusions： The distal radius stages R7-R9 and distal ulna stages U5-U7 indicate the high height velocity, high spinal growth velocity and high angle velocity. The DRU scoring system can serve as a good indicator for the growth potential and curve progression in braced IS patients.