Skeletal age determinations in children of European and African descent: Applicability of the Greulich and Pyle standards
Skeletal age determinations in children of European and African descent: Applicability of the Greulich and Pyle standards
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DOI：
10.1203/00006450-200111000-00015
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发表时间：
2001-11-01
影响因子：
3.6
通讯作者：
Gilsanz, V
中科院分区：
文献类型：
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作者：
Mora, S;Boechat, MI;Gilsanz, V
本研究评估了Greulich和Pyle方法在确定1980年以后出生的欧洲和非洲裔健康美国儿童的骨龄方面的价值。534名儿童（265名男孩，269名女孩; 260名欧洲裔美国人[EA]，274名非洲裔美国人[AA]）的手和手腕X线片，面积0至19岁，由两名经验丰富的儿科放射科医生进行分析，对受试者的实际年龄不知情。通过从两名评定者提供的平均骨龄评分中减去实际年龄，计算每例受试者的差异评分。进行单组t检验以验证平均差异评分等于零的假设。两名放射科医生的骨龄测定结果显示组内相关系数（r = 0.994）高度一致。骨骼和实足年龄差异的值的范围是非常广泛的，表明很大的个体差异。骨龄和实足年龄之间的比较仅在EA青春期前女孩中达到统计学显著性，其骨龄平均延迟3个月（t =-2.9; p = 0.005）。非洲裔青春期前儿童骨骼和实足英亩之间的平均差异为0.09 +/-0.66岁，而欧洲裔儿童为-0.17 +/-0.67岁（t = 3.13; p = 0.0019）。平均而言，在Greulich和Pyle图谱中，10%的青春期前AA儿童的骨龄高于正常数据2 SD，而8%的青春期前EA儿童的骨龄低于正常数据2 SD。相反，在青春期前的儿童中观察到的种族差异，EA青春期后的男性有显着更大的骨龄值比AA青春期后的男性（t = 2.03; p = 0.05）。总之，青春期前儿童骨骼成熟的变化大于Greulich和Pyle图谱中所反映的变化;与非洲血统的儿童相比，欧洲血统的青春期前美国儿童的骨骼成熟明显延迟;与青春期后AA男性相比，青春期后EA男性的骨骼成熟明显提前。需要新的标准来做出需要可靠骨龄的临床决策，并准确地代表多种族的儿科人群。
This study assesses the value of the Greulich and Pyle method in determining the skeletal ages of healthy American children of European and African descent born after the year 1980. The hand and wrist radiographs of 534 children (265 boys, 269 girls; 260 European-Americans [EA], 274 African-Americans [AA]), acres 0 to 19 y, were analyzed by two experienced pediatric radiologists blinded to the chronological age of the subjects. A difference score was calculated for each subject by subtracting chronological age from the mean bone ages scores provided by the two raters. One group t-tests were performed to verify the hypothesis that the mean difference score was equal to zero. Skeletal age determinations by the two radiologists showed a high degree of agreement by intraclass correlation coefficient (r = 0.994). The range of values for differences in skeletal and chronological ages was very wide, indicating great individual variability. Comparisons between skeletal and chronological age only reached statistical significance in EA prepubertal girls, whose skeletal ages were delayed, on average, by three months (t = -2.9; p = 0.005). Mean difference between skeletal and chronological acre in prepubertal children of African descent was 0.09 +/- 0.66 y, while that in children of European descent was -0.17 +/- 0.67 y; (t = 3.13; p = 0.0019). On average, the bone ages of 10% of all prepubertal AA children were 2 SD above the normative data in the Greulich and Pyle atlas, while the bone ages of 8% of all prepubertal EA children were 2 SD below. In contrast to the racial differences observed in prepubertal children, EA postpubertal males had significantly greater values for bone age than AA postpubertal males (t = 2.03; p = 0.05). In conclusion, variations in skeletal maturation in prepubertal children are greater than those reflected in the Greulich and Pyle atlas; prepubertal American children of European descent have significantly delayed skeletal maturation when compared with those of African descent; and, postpubertal EA males have significantly advanced skeletal maturation when compared with postpubertal AA males. New standards are needed to make clinical decisions that require reliable bone ages and to accurately represent a multiethnic pediatric population.