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Comparison of Three Methods of Assessing the Bone Age in Tibetan Children and the Features of Their Skeletal Maturity
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摘要:
目的 探讨更适用于藏族儿童的骨龄测定方法，并进一步总结藏族儿童的骨龄发育规律。 方法 回顾性收集2013年9月至2019年11月因外伤就诊于西藏自治区人民医院的4~18岁藏族儿童临床资料。研究对象均拍摄左手腕部X线片作为骨龄片。北京协和医院2名医生依据Greulich-Pyle(GP)图谱法共同阅片，得出GP图谱法骨龄。由人工智能骨龄系统自动阅片完成Tanner-Whitehouse3(TW3)法(包括TW3-RUS法和TW3-Carpal法)和中国人手腕骨发育标准-中华05.Ⅳ. (中华05)法骨龄测定。采用Pearson相关法分析GP图谱、TW3法、中华05法测定的骨龄与日历年龄的相关性。 结果 共305例符合纳入和排除标准的藏族儿童入选本研究。其中男童209例，女童96例；平均日历年龄(11.22±4.81)岁。Pearson相关法分析显示，GP图谱法、TW3-RUS法、TW3-Carpal法及中华05法测定的骨龄与藏族儿童日历年龄均高度相关，其中以GP图谱法的相关性最强(r=0.961)，其次为TW3-RUS法(r=0.941)、中华05法(r=0.937)、TW3-Carpal法(r=0.895)。藏族儿童普遍存在发育延缓；4~10岁儿童的骨龄不同程度地小于日历年龄；青春发育期(11~15岁)儿童的骨龄超过日历年龄(13岁男童除外)，呈追赶趋势，但16~18岁时的骨龄仍小于日历年龄。 结论 与TW3法、中华05法相比，GP图谱法更适用于藏族儿童的骨龄评估；藏族儿童的骨龄发育呈青春发育期追赶的趋势，但整体仍落后于日历年龄。 Abstract:Objective The aim of this study is to evaluate which of the three methods of assessing the bone age (BA), Greulich-Pyle (GP) atlas, Tanner-Whitehouse3 (TW3) and Chinese Hand Wrist Standard TW-China05, is most appropriate for Tibetan children, and to further investigate the BA characteristics of modern Tibetan children. Methods Radiographs of the left hand of Tibetan children aged 4 to 18 years who presented with trauma to Tibet Autonomous Region People's Hospital between September 2013 and November 2019 were retrospectively collected. BAs of these radiographs were analyzed by two experienced reviewers based on the GP atlas who came from Peking Union Medical College Hospital. A previously reported artificial-intelligence (AI) BA system was used for the TW3(including TW3-RUS and TW3-Carpal) and TW-China05 method. The Pearson correlation method was used to analyze the correlation between calendar age and BA determined by GP atlas, TW3 and TW-China05 methods. Results There were 305 Tibetan children (209 boys and 96 girls) with a mean calendar age of 11.22±4.81 years included in this study. Pearson correlation analysis showed that the BAs measured by the GP atlas, TW3-RUS, TW3-Carpal and TW-China05 methods are highly correlated with the calendar ages of Tibetan children, and the GP atlas has the strongest correlation (r=0.961), followed by TW3-RUS method (r=0.941), TW-China05 method (r=0.937), and TW3-Carpal method(r=0.895). From 4- to 10-year-old, the BAs of all Tibetan boys and girls were smaller than their calendar age with a difference degrees; subsequently, BAs showed a tendency of catch-up during puberty, but still lagging behind calendar ages from 16- to 18-years old. Conclusions Compared with the TW3 and TW-China05 methods, GP atlas may be the most accurate method of BA assessment for Tibetan children. BAs of modern Tibetan children shows catch-up trend during adolescence, but still lag behind calendar ages by the age of 18. -
Key words:
- bone age /
- Tibetan children /
- growth and development /
- artificial intelligence
编者按:援藏援疆是国家战略，是推动边疆发展稳定、促进各民族大团结的重大举措。为推动西藏自治区、新疆维吾尔自治区医疗卫生事业的发展，“十三五”期间，国家卫生健康委员会大力推进以医疗人才“组团式”援藏援疆为主要代表的卫生健康对口帮扶工作，将先进的诊疗技术和优秀的管理理念进行深入移植，全面提升了当地的医疗卫生服务水平。一直以来，医疗人才“组团式”援藏援疆工作稳步推进，精准施策，在提升当地医疗服务水平的同时，也开展了相对开创性的医学研究，积累了诸多宝贵经验。为此，我刊特别开设“援藏援疆专栏”，记录和发布援藏援疆系列宝贵经验和研究成果，以期为推动援藏援疆事业发展作出更大贡献。编者按:作者贡献：王凤丹、潘慧、银武、金征宇提出研究设计思路；次旦旺久、拉巴顿珠、王凤丹、顾潇、陈适、刘永亮、石磊进行数据整理和分析；次旦旺久、王凤丹完成文章初稿；所有作者均参与论文修改。编者按:利益冲突 无 -
表 1 不同方法测定的骨龄结果与日历年龄的相关性分析
评估方法 骨龄(x±s，岁) r值 总体(n=305) GP图谱法 10.64±5.18 0.961 TW3-RUS法 10.26±4.90 0.941 TW3-Carpal法 9.12±3.53 0.895 中华05法 10.46±4.41 0.937 男童(n=209) GP图谱法 11.00±5.26 0.958 TW3-RUS法 10.70±4.94 0.942 TW3-Carpal法 9.62±3.66 0.909 中华05法 10.88±4.43 0.938 女童(n=96) GP图谱法 9.85±4.95 0.968 TW3-RUS法 9.28±4.68 0.937 TW3-Carpal法 8.05±2.99 0.879 中华05法 9.53±4.23 0.935 
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表 2 不同年龄段藏族儿童GP图谱法骨龄与日历年龄的差值分布(x±s，岁)
CA
(岁)男童(n=209) 女童(n=96) 例数(n) CA BA BA-CA P值 例数(n) CA BA BA-CA P值 4 20 4.10±0.23 3.64±0.51 -0.96±1.19 0.002 12 4.05±0.08 3.46±0.73 -0.59±0.76 0.021 5 12 5.09±0.22 4.18±0.69 -1.71±1.32 0.001 7 5.13±0.34 4.56±0.64 -0.57±0.53 0.028 6 16 6.25±0.38 4.94±0.89 -1.31±0.97 0.000 9 6.01±0.03 5.02±1.08 -0.99±1.08 0.025 7 10 7.11±0.21 5.36±1.14 -1.75±1.17 0.001 5 7.14±0.13 5.68±2.04 -1.46±2.12 0.198 8 13 8.21±0.30 7.06±1.63 -1.15±1.61 0.025 8 8.10±0.24 7.38±1.10 -0.73±1.02 0.084 9 9 9.04±1.33 8.56±1.93 -0.49±1.89 0.461 3 9.27±0.31 8.53±1.37 -0.73±1.55 0.499 10 13 10.08±0.22 9.10±1.72 -0.99±1.62 0.049 6 10.12±0.16 9.40±1.73 -0.72±1.66 0.337 11 8 11.18±0.31 11.50±1.63 0.62±2.97 0.543 4 11.10±0.20 11.33±1.97 0.23±1.94 0.831 12 12 12.14±0.25 12.54±1.97 0.40±1.95 0.492 5 12.08±0.18 10.92±1.68 -1.22±3.45 0.169 13 9 12.28±0.34 12.17±1.41 -1.11±1.42 0.047 5 13.34±0.27 13.80±0.76 0.46±0.50 0.110 14 16 14.21±0.33 14.77±2.12 0.56±1.97 0.272 4 14.30±0.35 14.70±1.33 0.40±1.11 0.524 15 12 15.23±0.32 16.06±1.48 0.83±1.44 0.086 6 15.29±0.24 15.08±1.16 0.28±2.71 0.737 16 16 16.21±0.30 16.06±0.96 -0.14±1.00 0.572 9 16.01±0.04 15.35±1.23 -0.66±1.26 0.180 17 20 17.11±0.23 16.52±1.10 -0.59±1.05 0.022 6 17.28±0.30 15.67±1.17 -1.62±1.23 0.023 18 22 18.31±0.36 17.36±1.62 -0.96±1.67 0.014 6 18.17±0.29 17.17±0.98 -1.96±2.44 0.044 CA：日历年龄; BA：骨龄
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