关于《大骨节病诊断》标准中X线影像下指骨骨骺等径期前的限定是否应扩展为超径期前的探讨

目的:探讨现行《大骨节病诊断》标准（WS/T 207-2010）中儿童大骨节病诊断时"等径期前"这一限定是否合理，同时为《大骨节病诊断》标准（WS/T 207-2010）的修订提供基础数据和技术支撑。方法:2018年选择黑龙江省大骨节病历史病区作为调查点，拍摄调查点全部7 ~ 12岁儿童的右手X线正位片，根据其指骨骨骺...

Whether the limitation of the phalangeal epiphysis"before the equal-diameter period"should be extended to"before the ultra-diameter period"in X-ray diagnosis of Kashin-Beck disease

Objective To explore whether the limit of"before the equal-diameter period"is reasonable in the current criteria for"Diagnosis of Kashin-Beck Disease"(WS/T 207-2010)in children,and to provide basic data and technical support for revision of the criteria for"Diagnosis of Kashin-Beck Disease"(WS/T 207-2010).Methods In 2018,the historical Kashin-Beck disease(KBD)areas in Heilongjiang Province were selected as the investigation sites.The right-hand X-ray films of all children aged 7-12 years old were taken.According to the different X-ray manifestations of the growth and development of the phalangeal epiphysis,they were divided into five periods:before the equal-diameter period,equal-diameter period,ultra-diameter period,pre-closure period and closure period.Firstly,after stratifying by basic data such as age and gender,the data were standardized and analyzed.Secondly,the detection rates of metaphysis-epiphysis(CRME)in each period were calculated and compared.Finally,based on the mean value of the detection rate of metaphyseal change in Linkou and Fuyu counties of Heilongjiang Province in 1990,the rates of expected detection and missed diagnosis of metaphyseal changes of KBD among investigated children were calculated and compared under the limitation of before the equal-diameter period,before the ultra-diameter period or age range reduction.Results A total of 5019 children were investigated.The proportion of children before the equal-diameter period was 53.94%(2707/5019),and that of before the ultra-diameter period was 77.92%(3911/5019).The results showed that the equal-diameter period mainly appeared in 7-10 years old,and showed a decreasing trend with the increase of age(χ²_trend=390.10,P<0.05);the ultra-diameter period mainly occurred in 10-12 years old,showing a decreasing trend with the increase of age(χ²_trend=65.39,P<0.05);the pre-closure period mainly occurred in 10-12 years old,with an increasing trend with the increase of age(χ²_trend=51.86,P<0.05);the closure period mainly occurred in 11-12 years old and increased with age(χ²_trend=7.58,P<0.05).The CRME of children in ultra-diameter period was 14.78%(158/1069),however CRME did not occur in children with equal-diameter period.Among children before equal-diameter period,before ultar-diameter period and aged 7-10 years old,the expected detection rates of metaphyseal changes of KBD were 5.90%,8.53%and 7.42%,respectively.The expected missed diagnosis rates of metaphyseal changes of KBD were 5.06%,2.45%and 3.52%,respectively.Conclusion In order to improve the rate of expected detection and lower the rate of missed diagnosis of metaphyseal changes of KBD,children in"equal-diameter period"should be included in X-ray diagnosis and disease monitoring of KBD.