Objective: To explore the interrelationship among three simplified hand and wrist bone age assessment methods and to establish corresponding bone ages for each substage in male children. Methods: This retrospective case series study included 169 left hand and wrist X-rays from 152 male children who underwent bone age assessments at the Pediatric Orthopedics and Pediatrics Departments,Beijing Jishuitan Hospital,Capital Medical University from January 2019 to December 2023. The age at the time of X-ray was (13.7±2.0) years (range:9.1 to 17.9 years). Reasons for bone age assessment included evaluating the progress of adolescent idiopathic scoliosis in 36 cases, predicting limb length discrepancies in 28 cases, and predicting the height of healthy adolescents in 88 cases. Bone age was first graded using the Chinese hand-wrist bone age assessment method. Three simplified hand and wrist bone age assessment methods were then applied:Sanders simplified skeletal maturity staging system(Sanders stage), the distal radius and ulna classification (DRU), and e thumb ossification composite index (TOCI). Somers'delta correlation test was used to analyze the relationship among the results of the three simplified methods. The bone age and standard deviation for each sub-stage were calculated, and gender differences in bone age for the same sub-stage were compared with previous study. Results: The DRU, TOCI and Sanders stages showed a strong correlation when assessing bone age in male children, with Somers'delta correlation coefficients ranging from 0.881 to 0.876 (all P<0.01). The sub-stages with the smallest standard deviations (shorter duration) in each of the three classifications can serve as a quick reference for determining precise bone age, included proximal thumb epiphysis covered, without sesamoid (12.0 years);proximal thumb epiphysis covered with sesamoid or distal radial covered (13.0 years), early capping of the thumb epiphysis, radial epiphysis medial side capping(13.5 years), all phalangeal epiphyses capping (14.0 years), distal phalangeal physes beginning to close (14.5 years), all distal phalangeal physes closed (15.0 years), middle or proximal phalangeal physes beginning to close (15.5 years), all digital epiphyses closed (16.5 years), and nearly complete distal radius fusion with a notch (17.5 years). On average, the bone ages of males were 2 years behind those of females in the same substage. Conclusions: The DRU, TOCI, and Sanders stages can be applied to male children, and it is showed good correlation between them. The subtypes with shorter duration can be used as a quick assessment method to determine the bone age.
目的： 探讨三种简明手部骨龄分析法判断男童骨龄的相关性，明确其各亚分期的标准化骨龄。 方法： 本研究为回顾性病例系列研究。收集2019年1月至2023年12月于首都医科大学附属北京积水潭医院小儿骨科和小儿内科门诊进行骨龄测评的152例男童的左手和左腕的X线片。共收集X线片169张，拍摄时年龄（13.7±2.0）岁（范围：9.1~17.9岁）。行骨龄测评原因包括评估特发性脊柱侧凸进展36例，预测双下肢长度差异28例，预测健康青少年的身高88例。先采用中国人手腕骨发育标准法对X线片提示的骨龄进行标准化判断，再分别采用三种简明手部骨龄分析法，指骨骨骺分级系统（Sanders分级）、尺桡骨远端骨龄分级（DRU）桡骨分级、拇指骨骺分级（TOCI），对X线片提示的骨龄进行分级。采用Somers′delta相关性检验分析三种简明手部骨龄分析法得到结果的相关性；计算三种分析法各亚分期的平均骨龄及标准差，并结合既往文献结果对比同一亚分期中男童与女童的骨龄差距。 结果： Sanders分级、DRU桡骨分级和TOCI对男童的骨龄判断结果有良好的相关性，Somers′delta相关系数为0.881~0.876（P值均<0.01）；三种分级中对应骨龄标准差最小的亚分期，可用作判断骨龄具体数值的快速方法，包括：拇指近端骨骺覆盖（12.0岁），拇指籽骨刚出现或桡骨远端覆盖（13.0岁），拇指近端骨骺初成帽状或桡骨桡侧呈帽状（13.5岁），全部指骨骨骺呈帽状（14.0岁），远端指骨开始融合（14.5岁），远端指骨完全融合（15.0岁），近中指骨开始融合（15.5岁），近中指骨完全融合（16.5岁），桡骨远端几乎融合（17.5岁），同一亚分期下男童和女童的骨龄平均相差2岁。 结论： Sanders分级、DRU-桡骨分级、TOCI均可应用于判断男童的骨龄，并具有良好的相关性，其中特征性亚分期可作为骨龄的简易判断方法。.