摘要目的 探讨拇指骨骺评分(TOCI)作为Risser征的补充指标在青少年特发性脊柱侧凸(AIS)患儿生长潜能评估中的应用价值.方法 选取2006年5月至2014年5月于南京鼓楼医院门诊接受支具治疗的49例女性AIS患儿为研究对象,于每次随访时拍摄的全脊柱正侧位X线片及左手正位X线片上测量TOCI评分、Risser征及指骨骨龄评分(DSA),随访间隔为4～6个月.记录患儿每次随访时的实足年龄和纵向身高等一般资料,据此计算患儿每次随访时的身高生长速率(HV).所得结果与TOCI评分和Risser征作Spearman相关性分析.结果 TOCI评分与Risser征、DSA评分均呈显著相关(r=0.962、0.813,均P＜0.01).Risser征与DSA评分亦有明显相关性(r=0.822,P＜0.01).处于Risser征0、1级的TOCI评分与DSA评分的相关程度高于Risser征与DSA评分的相关程度(0.918比0.792,P＜0.01).随访处于TOCI5的HV为(7.1±2.1)cm/年,显著高于处于其他TOCI评分的HV(均P＜0.01).结论 TOCI 5提示AIS患儿具有较高的身高生长速率和生长潜能.TOCI评分可用于预测AIS患儿生长潜能并可作为Risser征的补充指标应用于临床,且其预测能力可能优于Risser征.

abstractsObjective To compare and analyze the correlations between thumb ossification composite index (TOCI),Risser sign and digital skeletal age (DSA) scores and to verify the possibility of TOCI as a supplementary to Risser sign in the evaluation of growth potential of adolescent idiopathic scoliosis (AIS) patients.Methods Forty-nine AIS patients undergoing bracing treatment between May 2006 and May 2014 were selected from Nanjing Drum Tower Hospital.The follow-up interval was 4-6 months.The following data at each visit were routinely collected,including TOCI and DSA scores,as well as chronologic age and standing height.The height velocity (HV) at each visit was calculated based on the above data.All results were analyzed by Spearman correlation with TOCI and Risser sign.Results There were strong correlations between TOCI and Risser sign and DSA scores (r=0.962,0.813,both P＜0.01).In AIS patients whose Risser sign were 0-1,the correlation between TOCI and DSA scores was more pronounced,compared with the correlation between Risser sign and DSA scores (0.918 vs 0.792,P＜0.01).The HV averaged (7.1±2.1) cm/year in TOCI 5,significantly larger than these in other TOCI scores (all P＜ 0.01).Conclusions The TOCI 5 can be a sign of high height velocity and high growth potential in AIS patients.TOCI is a valid indicator of skeletal maturity evaluation and can be used as a helpful supplementary to Risser sign,whose predictive ability may be better than Risser sign.