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

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。

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.