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

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,P0.001)。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。     

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

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DSA Ⅱ期和DSA Ⅲ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.     

多维度评估对特发性脊柱侧凸进展高峰期的预测价值

目的:通过多维度评估特发性脊柱侧凸(idiopathic scoliosis,IS)患儿侧凸进展高峰期(peak angle velocity,PAV)的相应成熟度指标,探讨其对PAV的预测价值。方法:选取初诊时月经未至、Risser征0级,Y三角软骨未闭、以半年为周期随访至少5次且进展超过5°的女性IS患儿30例,初诊年龄为10.8±1.5岁(7.8~12.1岁)。随访时收集及测量的指标包括实足年龄、Y三角软骨闭合状态、Risser征、身高、主弯Cobb角和骨龄(digital skeletal age,DSA)评分。计算每个随访周期内的身高增长速度(height velocity,HV)和Cobb角增长速度(angle velocity,AV)。采用逻辑回归分析各维度指标对PAV的预测价值。结果:30例患儿的PAV年龄为11.8±1.3岁(10~15岁),PAV时的身高为150.7±4.8cm,DSA评分为479.4±56.5,主弯Cobb角为26.5°±7.2°,HV为8.3±3.7cm/年,AV为7.8°±5.2°/年。PAV主要发生于Risser征0级(80.0%)和1级(20.0%)。逻辑回归分析结果显示PAV的发生与实足年龄介于11~13岁之间(OR=3.166,P=0.032)、Y软骨闭合(OR=6.365,P0.01)、Risser征0级(OR=12.963,P0.01)、DSA评分介于400~500之间(OR=10.758,P=0.011)、HV6cm/年(OR=4.346,P=0.025)、Cobb角30°(OR=9.535,P=0.013)呈显著相关。结论:年龄介于11~13岁之间、Risser征0级伴Y软骨闭合、DSA评分介于400~500之间、HV6cm/年和Cobb角30°为女性IS患儿侧凸PAV的高危因素,可用于预测PAV的发生,评估侧凸进展风险。     

脊柱生长速率对行支具治疗的特发性脊柱侧凸患儿侧凸进展的预测价值

【摘要】 目的：分析行支具治疗的特发性脊柱侧凸（idiopathic scoliosis,IS）患儿侧凸进展速率（Cobb velocity,CV）的相关因素,并探讨脊柱生长速率（spine length velocity,SLV）对IS患儿侧凸进展的预测价值。方法：于我院门诊行正规支具治疗的女性IS患儿23例,初诊时Risser征为0,无神经系统异常。其中胸主弯19例,胸腰弯4例,平均随访3.3年。患儿每次随访均拍摄站立位全脊柱正位片及左手掌正位片,测量主弯的Cobb角、Risser征、脊柱长度及骨龄（digital skeletal age,DSA）评分。另外记录患儿每次随访时的实足年龄、月经状态及身高等资料,计算患儿每次随访时的CV、SLV及身高生长速率（height velocity,HV）。采用Spearman相关系数分析IS患儿SLV及CV的相关因素。结果：本组患儿平均初诊年龄10.8±1.3岁;月经年龄12.2±2.0岁;初诊DSA评分384.6±51.9;初诊脊柱长度311.6±23.6mm;平均初诊身高145.5±7.8cm;平均初诊Cobb角23.0°±6.9°。随访时患儿平均SLV为19.1±17.1mm/年;平均HV为5.4±4.1cm/年;平均CV为5.7°±8.1°/年。另外,SLV高峰期（大于20mm/年）与CV高峰期（大于5°/年）均发生于实足年龄10～13岁之间。Spearman相关性分析表明,SLV与实足年龄、Risser征、DSA评分、HV及CV呈显著相关（r=-0.337、-0.292、-0.199、0.374和0.456,P<0.05）;CV与实足年龄、DSA评分及HV呈显著相关（r=-0.192、-0.188和0.281,P<0.05）。结论：IS患儿侧凸进展速率与年龄、DSA评分、HV及SLV显著相关。SLV与年龄、Risser征、DSA评分及HV显著相关,是较好的评估IS患儿生长潜能和侧凸进展的指标。SLV大于20mm/年时提示较高的侧凸进展风险。     

青少年特发性脊柱侧凸生长潜能评估的研究进展

青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）的发生发展与生长发育状态,即患儿的生长潜能密切相关。AIS相关的流行病学和自然史研究表明其出现及加重多在青春期生长发育的高峰期[1-4],且成熟的脊柱侧凸发生严重进展的风险明显小于处于生长发育高峰期的患者[5-7]。因此了解青少年正常的生长发育过程并对每位AIS患儿的生长潜能做出相对准确的评估,对于临床治疗策略的制定和预后评估意义重大[8]。由于生长发育的成熟度是多维的,包含多个组成部分,其与侧凸进展的相关性不尽一致,本文就脊柱侧凸畸形相关生长潜能评估方法的进展及其临床意义做一综述。     

褪黑素在特发性脊柱侧凸中的作用

特发性脊柱侧凸（ｉｄｉｏｐａｔｈｉｃｓｃｏｌｉｏｓｉｓＩＳ）是青少年和儿童脊柱畸形最常见的类型。它以脊柱在冠状面上的向侧方弯曲为主要特征,同时伴有矢状面上的轻度后凸和椎体在脊柱纵轴上的旋转。由于一般是在青春期发病,所以青少年型特发性脊柱侧凸（ａｄｏｌｅｓｃｅｎｔｉｄｉｏｐａｔｈｉｃｓｃｏｌｉｏｓｉｓ,ＡＩＳ）在临床上最常见。如果将诊断标准定为Ｃｏｂｂ角＞１０°,ＡＩＳ的发病率是３％左右。如果诊断标准为Ｃｏｂｂ角＞２０°,发病率降为０．３％１。大多数患者侧凸相对较轻且稳定,少数患者侧凸会不断加重并…     

特发性脊柱侧凸患者体感诱发电位研究

特发性脊柱侧凸存在多种解剖畸形,对心肺生理功能影响已有较多研究报告。为探讨脊柱侧凸对脊髓生理功能的影响,作者观察了Ｃｏｂｂ角６０°以上特发性脊柱侧凸患者体感诱发电位的变化。临床资料脊柱侧凸患者６８例,男３６例,女３２例,平均年龄１８６岁（１２～３６...     

青少年特发性脊柱侧凸的治疗进展

青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)是指年龄在10¹8岁,冠状面上Cobb角>10°伴有椎体的旋转而无其他器质性病变的一种常见病。该疾病能够导致身体外观畸形、疼痛,甚至心肺功能受损,严重影响了患者的身心健康及生活质量。在治疗上,对于轻中度的AIS患者常用定期观察、支具等保守治疗方法,能够有效的延缓侧凸的进展;对于保守治疗无效,达到手术阈值的AIS患者,则建议手术治疗,目前较为常用的手术方法是以椎弓根螺钉内固定系统为代表的后路椎体融合术,往往能够达到较好的临床疗效。近年来,由于物理治疗性脊柱侧凸特异性运动(PSSE)疗法安全有效,越来越受欢迎。目前对于AIS患者治疗的具体适应证正逐渐完善,治疗理念与技术在不断更新,临床疗效也不断得到改善。本文将从保守治疗和手术治疗两方面展开,主要阐述常用的治疗方法在临床上的进展和应用以及所面临的问题,为临床治疗的选择提供参考。     

青少年脊柱侧凸畸形患者超声心动图异常分析:特发性脊柱侧凸与先天性脊柱侧凸的比较

背景:脊柱畸形患者可合并有超声心动图(ultrasonic cardiography,UCG)结果异常,但文献中缺乏特发性脊柱侧凸(idiopathic scoliosis,IS)与先天性脊柱侧凸(congenital scoliosis,CS)患者UCG异常的比较.目的:比较青少年IS患者与CS患者UCG结果异常的发...     

前路松解术在重度青少年特发性脊柱侧凸治疗中的价值

目的探讨前路松解在重度青少年特发性脊柱侧凸治疗中的作用. 方法回顾性分析1998年1月至2001年12月间26例重度脊柱侧凸的手术治疗结果,其中男7例,女19例;年龄平均15岁(10～21岁).24例可根据King对特发性脊柱侧凸的分型,其中King Ⅰ 4例,King Ⅱ 9例,King Ⅲ 5例,King Ⅳ 4例,King Ⅴ 2例;另2例为胸腰段侧凸.术前站立位主侧凸平均89.8°,重力悬吊牵引位平均66.5°,反向弯曲位平均67.7°,支点反向弯曲平均为61.2°,胸椎后凸平均43.5°.术前顶椎偏离骶正中线的距离为39.7 mm.前路松解后一期行后路手术6例,2周后二期行后路手术治疗20例. 结果 20例二期后路手术者,前路松解术后脊柱活动度与术前悬吊位X线片比较,平均增加了17.8°.术后主侧凸冠状面Cobb角平均52.6°,胸椎后凸28.4°.冠状面平均矫正38.2°,矫正率平均43.1%,术后顶椎偏离骶正中线的距离为9.9 mm.随访时间平均2.3年(6个月～4年),随访时主侧凸平均Cobb角54.9°,矫正丢失6.4%,无断棍、植骨不融合及假关节的病例. 结论重度侧凸术前侧凸的柔韧性<20%的患者,单纯前路松解对增加脊柱的活动度意义不大,术后畸形的矫正效果不佳,应考虑前路的截骨来增加脊柱的柔韧性以使侧弯得到最大限度的矫正.     

Assessment of curve progression in idiopathic scoliosis

In a 5-year prospective study on idiopathic scoliosis, an attempt was made to elucidate the natural history of the disease and to determine which factors contribute to curve progression. A total of 85,622 children were examined for scoliosis in a prospective school screening study carried out in northwestern and central Greece. Curve progression was studied in 839 of the 1,436 children with idiopathic scoliosis of at least 10° detected from the school screening program. Each child was followed clinically and roentgenographically for one to four follow-up visits for a mean of 3.2 years. Progression of the scoliotic curve was recorded in 14.7% of the children. Spontaneous improvement of at least 5° was observed in 27.4% of them, with 80 children (9.5%) demonstrating complete spontaneous resolution. Eighteen percent of the patients remained stable, while the remaining patients demonstrated nonsignificant changes of less than 5° in curve magnitude. A strong association was observed between the incidence of progression and the sex of the child, curve pattern, maturity, and to a lesser extent age and curve magnitude. More specifically, the following were associated with a high risk of curve progression: sex (girls); curve pattern (right thoracic and double curves in girls, and right lumbar curves in boys); maturity (girls before the onset of menses); age (time of pubertal growth spurt); and curve magnitude (≥ 30°). On the other hand, left thoracic curves showed a weak tendency for progression. In conclusion, the findings of the present study strongly suggest that only a small percentage of scoliotic curves will undergo progression. The pattern of the curve according to curve direction and sex of the child was found to be a key indicator of which curves will progress. Received: 4 October 1997 Revised: 10 February 1998 Accepted: 11 March 1998     

Platelet pathology in minimal curve idiopathic scoliosis: an attempt to predict curve progression

Platelets from adolescents with minimal curve scoliosis (mcs) (7-18 degrees) and healthy control subjects were examined for morphometry under the electron microscope and tested for calcium content and surface negative charge. These parameters have previously been found to be abnormal in severe idiopathic scoliosis (is) patients. Significantly more patients than control subjects showed deviations from normal in all tests. Two tests in particular, the average number of dense bodies per cell and an increased surface negative charge, were the most frequent abnormalities. In an attempt to assess the possibility of using platelet tests for prediction of curve progression, statistical comparisons were made and discriminant scores were generated for each patient. The results were compared with the clinical findings after a 2- to 3.5-year follow-up. The predictions proved to be incorrect although each of the five patients who had curve progression had some platelet abnormality. It is concluded that although platelet pathology does occur in early idiopathic scoliosis, it cannot be used as a prognostic indicator of curve progression.     

A new risk classification rule for curve progression in adolescent idiopathic scoliosis

Background context

Prognostic factors for curve progression of adolescent idiopathic scoliosis (AIS) have been reported previously. There is only one existing rule that classifies AIS patients into two groups by a curvature of 25°.

Purpose

This study aimed to develop a more refined risk classification rule for AIS.

Study design

This was a retrospective cohort study.

Patient sample

We examined 2,308 untreated AIS patients, aged 10 years and older, who had a Risser sign of 2 and lesser and a curvature less than 30° at presentation.

Outcome measures

Outcome was taken as the time to progression to 30°.

Methods

Patients' clinical parameters were analyzed by Classification and Regression Tree analysis.

Results

The new classification rule identified four risk groups of curve progression. Patients with a curvature of 26° and more and less than 18° constituted the highest and lowest risk groups, respectively. The two intermediate groups were identified by the age (11.3 years), menarcheal status, and body height (154 cm).

Conclusions

The risk classification rule only uses information at the first presentation and can aid physicians in deriving an efficient management.     

女性青少年特发性脊柱侧凸患者停止支具治疗后的侧凸进展及其相关因素

目的 :分析发育成熟的女性青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患儿在停止支具治疗后长期随访中的侧凸进展情况,并探讨其相关因素。方法:回顾性分析于我院门诊就诊符合SRS(scoliosis research society)支具治疗标准的女性AIS患儿130例,初诊年龄11.8±1.4岁(10~14岁)。所有患儿均随访至支具治疗结束后至少2年,且至少具有佩戴支具后初次随访、停止支具治疗时、停止支具治疗后6个月、1年、2年及末次随访时的资料。在每次随访时的全脊柱正位X线片上测量主弯侧凸Cobb角,并评估侧凸进展超过5°的患儿及比例、侧凸进展度数和进展速率。末次随访时侧凸进展超过5°定义为侧凸进展,采用独立样本t检验比较侧凸进展组和非进展组患儿的初诊年龄、月经初潮年龄、初诊Cobb角、初始矫正率、停止支具治疗年龄。结果:与停止支具治疗时相比,停止支具治疗后6个月、1年、2年及末次随访时的侧凸进展超过5°的患儿分别为33例(25.4%)、42例(32.3%)、61例(46.9%)和63例(48.5%);侧凸进展度数分别为2.0°±4.4°、3.2°±5.0°、4.9°±5.5°和5.1°±6.9°;侧凸进展速率分别为0.33°±0.71°/月、0.20°±0.41°/月、0.14°±0.29°/月和0.01°±0.19°/月。停止支具治疗后侧凸非进展组和进展组患儿的初诊年龄、月经初潮年龄、初诊Cobb角、初始矫正率、停止支具治疗时年龄等无显著性差异(P0.05),而停止支具治疗时的Cobb角有统计学差异(P0.05)。结论:行支具治疗的AIS患儿停止支具治疗后仍有较高的侧凸进展风险,停止支具治疗后的6个月内为侧凸进展高风险和高速率期;停止支具治疗时的侧凸Cobb角越大发生侧凸进展的风险越高。     

Spinal deformity progression after posterior segmental instrumentation and fusion for idiopathic scoliosis

Study design

Retrospective chart and radiographic review.

Purpose

To assess the incidence of and variables associated with spinal deformity progression after posterior segmental instrumentation and fusion at a single institution. Progression of the scoliotic deformity after posterior instrumented spinal fusion has been described. Recent studies have concluded that segmental pedicle screw constructs are better able to control deformity progression.

Methods

Retrospective review of a consecutive series of idiopathic scoliosis patients (n = 89) with major thoracic curves (Lenke types 1–4) treated with posterior segmental instrumentation and fusion. Deformity progression was defined as a 10° increase in Cobb angle between the first-erect and 2-year post-operative radiographs. Clinical and radiographic data between the two cohorts (deformity progression versus stable) were analyzed to determine the variables associated with deformity progression.

Results

Patients in the deformity progression group (n = 13) tended to be younger (median 13.7 vs. 14.7 years) and experienced a significant change in height (p = 0.01) during the post-operative period compared to the stable group (n = 76). At 2-years post-op, the patients in the deformity progression group had experienced a significantly greater change in upper instrumented vertebra (UIV) angulation, lower instrumented vertebra (LIV) angulation, and apical vertebral translation (AVT). Two-year post-op Scoliosis Research Society questionnaire (SRS-22) scores in the appearance domain were also significantly worse in the deformity progression group. Patients in the deformity progression group had a significantly greater difference between the lowest instrumented vertebra and stable vertebra compared to patients in the stable group (p = 0.001).

Conclusions

Deformity progression after posterior spinal fusion does occur after modern segmental instrumentation. Segmental pedicle screw constructs do not prevent deformity progression. Skeletally immature patients with a significant growth potential are at the highest risk for deformity progression. In immature patients, extending the fusion distally to the stable vertebra may minimize deformity progression.

Level of evidence

Level III.     

The association of disproportionate skeletal growth and abnormal radius dimension ratio with curve severity in adolescent idiopathic scoliosis

Abnormal anthropometric measurements during the peripubertal growth spurt have been documented in adolescent idiopathic scoliosis (AIS). Magnetic resonance (MR) imaging studies of the spine have suggested a disproportionate endochondral and membranous ossification in AIS. The present study aimed at investigating whether disproportional ossification and skeletal growth occurred in the peripheral bone of AIS patients using the radius as the target bone. Skeletally mature AIS girls with different severity (n = 290) and age-matched control healthy girls (n = 80) were recruited. The anthropometric parameters were recorded. The midshaft of non-dominant radius was scanned with peripheral quantitative computed tomography (pQCT) and the radius diameter was calculated from the cross-sectional area. Radius dimension ratio was derived from the ratio of radius diameter to radius length. The anthropometric parameters were compared between AIS and control with adjustment for age. The radius dimension ratio was further correlated with curve severity in AIS girls using Pearson’s correlation test. The analysis showed that the arm span and radius length were slightly longer in AIS girls. The BMI of AIS girls was significantly lower than the controls. The radius dimension ratio in severe AIS girls was significantly lower than the controls and the ratio of AIS girls correlated with the curve severity (r = −0.120; p = 0.039). The abnormal radius dimension ratio supported the presence of systemic growth abnormalities in AIS. Disproportional endochondral-membranous ossification could explain for the observation. The observation of the association of radius dimension ratio with curve severity provides an important potentially clinically measurable parameter for further longitudinal studies on the prognostication of curve progression in AIS.     

Utilization of distal radius and ulna classification scheme in predicting growth peak and curve progression in idiopathic scoliosis girls undergoing bracing treatment

Distal radius and ulna (DRU) classification scheme has been proposed for predicting skeletal maturity in patients with idiopathic scoliosis (IS). However, the utilization of DRU classification scheme in the assessment of growth peak and curve progression in IS was still inconclusive. This study aimed to correlate the distal radius and ulna stages with several indicators for growth potential and to evaluate the predictive value of DRU system for curve progression in braced female IS patients. This was a consecutive longitudinal study including physically immature IS girls receiving standardized bracing treatment and regularly followed up every 3–6 months until brace weaning. The following data of each visit were collected: chronologic age, standing height, Cobb angle, spinal length, Risser sign, digital skeletal age (DSA) scores and DRU scores. The height velocity (HV), spinal growth velocity (SGV) and angle velocity (AV) of each visit were calculated. The correlation among radius stage, ulna stage, Risser sign, height, spinal length, HV, SGV and AV was studied. Forty braced IS girls with 349 longitudinal whole spine X-rays were reviewed. The average DRU scores at initial visit were R6.5 ± 1.1 and U4.5 ± 1.2 for radius and ulna, respectively. Both the radius stages between R5 and R8 and ulna stages between U3 and U6 indicated high SGV and high HV. The DSA scores were 402.1 ± 48.8 and 430.8 ± 44.4 at R7 and R8, respectively. The AV values were − 5.9 ± 12.4°/y and − 0.4 ± 1.5°/y at R5 and R6, which increased to 5.9 ± 17.3°/y, 3.1 ± 15.7°/y and 4.2 ± 12.2°/y at R7, R8 and R9, respectively. The DSA scores were 387.3 ± 65.7 for U5 and 432.9 ± 48.5 for U6, respectively. The AV values were − 3.1 ± 0.3°/y at U3, − 1.7 ± 9.3°/y at U4, 2.3 ± 16.1°/y at U5, 5.4 ± 15.5°/y at U6 and 4.4 ± 12.9°/y at U7. Both distal radius and ulna scores correlate with the longitudinal growth potential, and thus, the DRU scoring scheme is an alternative predictor for growth potential and curve progression in girls with IS. These slides can be retrieved under Electronic Supplementary Material.     

Assessment of skeletal maturity in scoliosis patients to determine clinical management: a new classification scheme using distal radius and ulna radiographs

BackgroundAssessment of skeletal maturity in patients with adolescent idiopathic scoliosis (AIS) is important to guide clinical management. Understanding growth peak and cessation is crucial to determine clinical observational intervals, timing to initiate or end bracing therapy, and when to instrument and fuse. The commonly used clinical or radiologic methods to assess skeletal maturity are still deficient in predicting the growth peak and cessation among adolescents, and bone age is too complicated to apply.PurposeTo address these concerns, we describe a new distal radius and ulna (DRU) classification scheme to assess skeletal maturity.Study designA prospective study.Patient sampleOne hundred fifty young, female AIS patients with hand x-rays and no previous history of spine surgery from a single institute were assessed.Outcome measuresRadius and ulna plain radiographs, and various anthropomorphic parameters were assessed.MethodsWe identified various stages of radius and ulna epiphysis maturity, which were graded as R1–R11 for the radius and U1–U9 for the ulna. The bone age, development of sexual characteristics, standing height, sitting height, arm span, radius length, and tibia length were studied prospectively at each stage of these epiphysis changes.ResultsStanding height, sitting height, and arm span growth were at their peak during stages R7 (mean, 11.4 years old) and U5 (mean, 11.0 years old). The long bone growths also demonstrated a common peak at R7 and U5. Cessation of height and arm span growth was noted after stages R10 (mean, 15.6 years old) and U9 (mean, 17.3 years old).ConclusionsThe new DRU classification is a practical and easy-to-use scheme that can provide skeletal maturation status. This classification scheme provides close relationship with adolescent growth spurt and cessation of growth. This classification may have a tremendous utility in improving clinical-decision making in the conservative and operative management of scoliosis patients.