拇指骨骺评分系统在女性青少年特发性脊柱侧凸患者围青春期生长潜能评估中的价值

Value of thumb ossification composite index for predicting peripubertal growth potential in girls with adolescent idiopathic scoliosis

目的探讨拇指骨骺评分系统（TOCI）在预测女性青少年特发性脊柱侧凸（AIS）患者生长潜能中的应用价值，并比较与其他成熟度指标的相关性。方法回顾性分析2006年10月至2013年8月于南京大学鼓楼院门诊行规范支具治疗的45例女性AIS患者。随访间隔为3-6个月直到停止支具治疗，每次随访时均拍摄站立位全脊柱正侧位片及左手掌正位片，测量主弯Cobb角、TOCI评分、指骨骨龄（DSA）评分及尺骨、桡骨、掌骨评分（RUS），另外记录患者每次随访时的实足年龄、月经状态及身高等资料，据此计算患者每次随访时的身高生长速率（HV）。比较分析TOCI评分与各成熟度指标的相关性以评估其对IS患者生长潜能的预测价值。结果45例患者初诊时平均年龄为（10．9±1．3）岁，平均月经初潮年龄为（12．6±1．3）岁，平均身高生长速率峰值（PHV）为（7．5±1．5）cm／年，PHV的平均年龄为（12．0±0．9）岁，71．8％的患者在TOCI5达到PHV。Spearman相关性分析表明，本组患者TOCI评分与DSA和RUS评分呈显著相关（r=0．96、0．97，均P〈0．001）。χ^2检验分析表明，TOCI5能准确预测PHV的发生（CramerV系数=0．531，P=0．007）。结论TOCI5预示AIS患者具有较高的生长潜能和HV。TOCI评分是一种简便且对AIS患者生长潜能具有较高预测能力的骨龄评分系统。

Objective To evaluate the predictive value of thumb ossification composite index （TOCI） for growth potential in female adolescent idiopathic scoliosis （AIS） patients and to analyze its correlation with several other indicators of growth potential. Methods A retrospective review was conducted on 45 girls with AIS who underwent standard bracing treatment between October 2006 and August 2013 in Nanjing Drum Tower Hospital. All patients were regularly followed up with an interval of 3 -6 months until brace weaning. At each visit, the following data were collected and recorded： chronologic age, stage of menses, standing height, Cobb angle of main curve, TOCI score, digital skeletal age （ DSA ） score and radius, ulna and small bones （RUS） score. The height velocity （HV） at each visit were calculated. The correlations analysis between TOCI and other indicators including DSA scores and RUS scores were studied. Results The average age at initial visit was （ 10. 9 ± 1.3 ） years. The mean age of menarche was （ 12. 6 ± 1.3 ） years. The mean peak height velocity （PHV） was （7.5 ± 1.5 ） cm/year and the mean age of PHV was （ 12. 0 ±0. 9） years. A total of 71.8% AIS girls attained their PHV at TOCI 5. The Spearman correlation analysis showed that TOCI was highly correlated with the DSA and RUS scores （ r = 0. 95 and 0. 96, both P 〈 0. 001 ）. Chi-square test showed that TOCI 5 accurately predicted the occurrence of PHV （ Cramer V = 0. 531, P = 0. 007 ）. Conclusion The TOCI 5 indicates high HV and high growth potential in AIS patients with bracing treatment. TOCI can thus serve as a good indicator for growth potential in braced AIS girls.