中国五城市儿童手腕部桡、尺、掌指骨骨龄与腕骨骨龄差异参考值

目的 观察中国城市儿童手腕部桡、尺、掌指骨骨龄与腕骨骨龄差异,为临床应用提供参考.方法 抽取上海、广州、温州、大连、石家庄5城市汉族健康儿童9408名,男5066名,女4342名,年龄1.5～13.5岁.采用<中国青少年儿童手腕骨成熟度及评价方法 >桡、尺、掌指骨(BUS)骨龄标准(TW3-C RUS)和腕骨(Carpal)骨龄标准(TW3-C Carpal),分别评价儿童的桡、尺、掌指骨骨龄和腕骨骨龄.采用Box-Cox幂指数分布模型(Box-Cox power exponential distribution,BCPE)建立TW3-CRUS与TW3-C Carpal骨龄差值的Z分值曲线评价图表,以Q检验和拟合的百分位数曲线下样本例数的百分数检验BCPE模型的拟合优度.结果男2.0～13.5岁、女1.5～11.5岁,各年龄组TW3-CBUS与TW3-C Carpal骨龄差值的平均数均接近于零,男童平均数范围在-0.19～0.17岁,女童平均数范围在-0.12～0.13岁;男童年龄组骨龄差值的标准差在0.47～1.01岁之间,达最大标准差时4.5岁;女童骨龄差值的标准差在0.49～0.82岁之间,达最大标准差时3.5岁.经Q检验,选择出了男女儿童骨龄差值BCPE模型,所拟合的百分位数曲线下样本例数的百分数与其理论百分位相差很小,除女第90百分位数相差1.00%外,均在0.66%以下.结论 男女儿童TW3-C RUS与TW3-CCarpal骨龄差值随年龄而增加,分别在男4.5岁和女3.5岁左右达到最大,其后逐渐下降至腕骨发育成熟.但变异程度存在性别差异,男性大于女性,10岁后性别差异减小.

Reference values of differences between TW3-C RUS and TW3-C Carpal bone ages of children from five cities of China

Objective The determination of skeletal maturity has an important role in pediatricclinical practice, especially in relation to endocrinological problems and growth disorders, and it is frequentlyuseful in diagnosis and monitoring treatment. It has been suggested that the difference between radius, ulnaand short bonse (RUS) and carpal may be of differential diagnostic significance. However, no data oncomparison among bone ages of Chinese children are available. The differences between TW3-Chinese RUS(TW3-C BUS) and TW3-Chinese Carpal (TW3-C Carpal ) bone age of Chinese children were observed inthis study to provide references for skeletal development estimation. Methods Totally 9408 Han healthychildren(5066 boys,4302 girls) aged 1.5 - 13.5 years from 5 cities of China were enrolled in this study.The bone ages of the children were estimated by TW3-C RUS and TW3-C Carpal. The Z score curves of thedifferences between them were fitted by BCPE distribution and the goodness-of-fit of Box-Cox powerexponential distribution (BCPE) models were assessed by Q-test and percents of cases of sample below thefitted percentile curves. Results The means of the differences between TW3-C RUS and TW3-C Carpalwere -0. 19 -0. 17 over the age 2. 0 - 13.5 years in boys and -0. 12 -0. 13 from age 1.5 - 11.5 years ingirls. The standard deviations were respectively 0. 47 - 1.01 years for boys and 0. 49 -0. 82 years for girls.The degrees of freedom, with respect to the parameter curves from BCPE distribution, were selected and thepercentile curves were fitted by BCPE. The differences between percents of cases below the fitted percentilecurves and expected values were all under 0. 66% , exception of difference for 90th percentile in girls.Conclusions The differences between TW3-C BUS and TW3-C Carpal varied with age, the standarddeviations increased gradually before 4. 5 years of age in boys and 4 years of age in girls, and afterwards thevariations decreased steadily until the TW3-C Carpal has reached full maturity. However, there was sexdiversity in the extent of the variations. The differences between TW3-C RUS and TW3-C Carpal for boyswere evidently greater than that for girls. The sex difference decreased progressively after 10 years. Theproposed Z scores curves charts should provide reference for clinical practice.