用全自动BoneXpert骨龄法测定0岁以上儿童掌骨皮质厚度、骨宽度和骨健康指数的参考值

H. H. Thodberg, P. Thrane, David D Martin
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引用次数: 2

摘要

BoneXpert自动骨龄方法于2009年推出,涵盖了男孩2.5岁和女孩2.0岁的Greulich-Pyle骨龄(BA GP)。这种方法最近被推广到新生儿身上。BoneXpert还对掌骨2-4的皮质厚度(T)、骨宽度(W)和长度(L)进行数字放射测量。由此方法得到皮质面积:A = π·W·T (1 - T/W),掌骨指数MCI = A / W2,骨健康指数BHI = A / (W1/3·L1/3)。本研究的目的是报告从BA GP 0.08岁开始的儿童骨骼测量的参考曲线。方法对1955年在巴黎出生的410名健康儿童在1、3、6、9、12、18个月时进行手部x光检查,此后每年随访一次,直至20岁。与BoneXpert自动确定的BA GP相比,设计了参考曲线,对桡骨、尺骨和19根短骨进行平均。结果雄虫T由BA GP 0.08 y时的0.74 mm降至BA GP 1 y时的0.58 mm,降幅达22%。结果(续)在同一时期,W从3.2 mm增加到4.4 mm增加了38%,A增加了19%。掌骨长度(L)增加43%,从16.4毫米增加到24毫米。MCI从0.55降至0.37 (33%),BHI从4.8降至3.4(29%)。雌性表现出类似的发育,但它们的皮质厚度在BA GP 0.9 y时已经达到最小值。在生命的第一年,婴儿表现出戏剧性的骨骼几何形状:骨宽度和长度急剧增加,皮质厚度减少21%。MCI和BHI在此期间下降。需要进一步的研究来调查这种皮质厚度的减少是否与1.0岁儿童与新生儿相比骨折风险的增加有关(Hedström 2010)。这种新方法可能是婴儿DXA的替代方法,因为:1)更容易记录手部x射线2)新的参考曲线提供z分数3)参考曲线是根据骨年龄而不是实足年龄表示的。Thodberg等人,通过自动放射测量得出的儿童骨指数。骨质疏松症;2010年8月;[21] .儿童与青少年骨折的流行病学研究。Hedström。骨科学报,2010年2月;81(1):148-53
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Reference values of cortical thickness, bone width, and Bone Health Index in metacarpals of children from age 0 y, as determined with an extension of the fully automated BoneXpert bone age method
Introduction The BoneXpert method for automated bone age was introduced in 2009, covering the Greulich-Pyle bone age (BA GP) down to 2.5 years for boys and 2.0 years for girls. The method was recently extended down to newborns. BoneXpert also performs digital radiogrammetry of the cortical thickness (T), the bone width (W) and length (L) in metacarpals 2-4. From these, the method derives the cortical area: A = π·W·T (1 – T/W), the metacarpal index MCI = A / W2, and the Bone Health Index (BHI) BHI = A / (W1/3·L1/3). The aim of this study is to report reference curves for bone measurements for children starting at BA GP 0.08 years. Methods 410 healthy children born in Paris in 1955 were followed with hand X-rays at ages 1, 3, 6, 9, 12 and 18 months, and then annually until age 20 years. Reference curves were de ned versus BA GP determined automatically with BoneXpert, averaging over radius, ulna and 19 short bones. Results For males, T drops from 0.74 mm at BA GP 0.08 y to a minimum of 0.58 mm at BA GP 1 y, a reduction of 22%. Results (continued) In the same period, W increases by 38% from 3.2 to 4.4 mm, and A grows by 19%. Metacarpal length (L) increases 43% from 16.4 to 24 mm. MCI drops from 0.55 to 0.37 (33%) and BHI from 4.8 to 3.4 (29%). Females display a similar development, but their cortical thickness assumes its minimum already at BA GP 0.9 y. Discussion In the rst year of life, infants exhibit a dramatic recon guration of bone geometry: Bone width and length increase strongly and cortical thickness decreases by 21%. MCI and BHI decrease in this period. Further studies are needed to investigate if this decrease in cortical thickness is related to the observed increase in fracture-risk in children at age 1.0 years compared to newborns (Hedström 2010). This new method could be an alternative to DXA in infants because: 1) It is easier to record a hand X-ray 2) The new reference curves provide Z-scores 3) The reference curves are expressed versus bone age rather than chronological age. References Thodberg et al., A paediatric bone index derived by automated radiogrammetry. Osteoporos Int. 2010 Aug; 21(8): 1391–1400 Hedström et al., Epidemiology of fractures in children and adolescents. Acta Orthop. 2010 Feb;81(1):148-53
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