Can Ossification Pattern of the Thumb Epiphyses Reliably Simplify the Classical Tanner-Whitehouse Hand Skeletal Maturity Assessment? A Study of 645 Hand Radiographs from 125 Premature AIS Girls followed Longitudinally till Skeletal Maturity
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摘要Summary
We compared the pattern of ossification of all epiphyses of thumb against those of the 4 ulnar digits in 645 hand radiographs, obtained from a prospectively recruited cohort of 125 pre-menarche girls with idiopathic scoliosis followed longitudinally at six months intervals till skeletal maturity. The reliability of the new proposed thumb epiphyses ossification based staging, could provide a potential simplified and alternative staging system that can
be used in busy outpatient clinical setting in assessment of skeletal maturity in AIS.

Hypothesis
Ossification pattern in thumb epiphyses can simplify and reliably represent the classical TWIII hand skeletal maturity assessment at peri-pubertal period in AIS. Design Retrospective longitudinal cohort study Introduction
Accurate skeletal maturity assessment is important in guiding clinical decision and prognostication in adolescent idiopathic scoliosis(AIS). Classical Greulich & Pyle atlas and Tanner- Whitehouse III method (TWIII) focus on ossification pattern of hand and wrist epiphyses are complicated for outpatient use with steep learning curve. The objective of study was to compare the ossification pattern of thumb epiphyses against all epiphyses of the 4 ulnar digits to determine the feasibility, reliability of a new proposed thumb epiphyses ossification based staging system.
Methods Hand radiographs of 125 pre-menarche girls newly diagnosed with AIS(age 8-12) followed up longitudinally at 6 months interval till skeletal maturity (minimum of 4 yrs) was included. The ossification pattern of the 3 thumb epiphyses were compared with all phalangeal and metacarpal epiphyses of the 4 ulnar digits using same TWIII descriptors of stage F, G, H and I. Correlations were analysed with Chi-square test and Cramer′s V correlation
method.

Results
A total of 645 hand X rays (average 5 from each AIS girl) and 11517 epiphyses were scored. The concordance rate of TWIII stage F, G ,I in thumb PP epiphysis versus all epiphyses of the 4 ulnar digits were 73.6%, 72.4% , 88.4% respectively. The overall concordance rate (including all epiphyses) was 71.3% with very high Cramer′s V correlation and statistical significance (p<0.0005).

Conclusion
Ossification pattern in thumb epiphyses strongly correlated with all epiphyses of the 4 ulnar digits and highly predictive of the TWIII staging. The reliability of the new proposed thumb epiphyses ossification based staging, subjected to further multicenter validation could provide a simplified alternative staging system for busy outpatient clinical setting in the assessment of skeletal maturity in AIS.
著者A. L. H. Hung, B. Shi, W. W. Chau, B. H. K. Yip, F. W. P. Yu, V. W. Y. Hung, B. K. W. Ng, T. P. Lam, J. C. Y. Cheng
會議名稱51st Annual Meeting of Scoliosis Research Society (SRS)
會議開始日21.09.2016
會議完結日24.09.2016
會議地點Prague, Czech Republic
會議國家/地區捷克共和國
出版年份2016
語言英式英語

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