Early Maturity as the New Normal: A Century-long Study of Bone Age
Early Maturity as the New Normal: A Century-long Study of Bone Age
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DOI：
10.1097/corr.0000000000000446
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发表时间：
2018-11-01
影响因子：
4.2
通讯作者：
Duren, Dana L.
中科院分区：
文献类型：
--
作者：
Boeyer, Melanie E.;Sherwood, Richard J.;Duren, Dana L.
背景 骨骺融合（EF）标志着纵向骨生长的完成，这是骨骼生长和/或发育障碍治疗过程中监测的一个关键里程碑。最近，儿童骨骼成熟加速的趋势已被记录。由于目前评估骨骼成熟度的方法包括早在 1930 年代出生的参考人群中的儿童，因此当代患者发生 EF 事件的时间可能与这些标准有很大不同。问题/目的 (1) 今天的儿童是否比成熟标准所依据的过去几代人更早地开始手和腕部的 EF 过程？ (2) 如今的儿童是否比过去几代人更早地完成手部和腕部的 EF 成熟标准？方法 这项回顾性观察性研究纳入了参与 Fels 纵向研究的 1292 名儿童（665 名男性，627 名女性），他们出生于 1915 年至 2006 年之间。每个参与者在童年时期都有 1 到 39 张连续的左手腕 X 光照片，这些照片是专门为研究目的而获得的。主要结果是根据 Fels 方法的标准，在桡骨和尺骨以及第一、第三和第五射线的掌骨和指骨中 EF 开始出现的第一个迹象时的实际年龄 (EF-I) 和 EF 完成时的首次实际年龄 (EF-C)。 EF 是一个可靠的指标，平均 kappa 一致性统计值为 0.91。使用惩罚 B 样条来模拟 EF-I 和 EF-C 年龄的变化，并通过对 1935 年和 1995 年出生的儿童进行主要比较来识别连续出生年份的变化。 结果 与 1935 年出生的儿童相比，1995 年出生的儿童大约有一半的手和手腕骨骺表现出较早的 EF-I 和/或较早的 EF-C。每个里程碑的年龄（EF-I 和 EF-C）均有所下降男性分别延长 6.7 个月和 6.8 个月，女性分别延长 9.8 个月和 9.7 个月。这种变化是在过去的一个世纪里逐渐发生的。越近端的特征（远端桡骨、远端尺骨和掌骨的 EF）更有可能经历时间变化，而指骨中的 EF 时间在整个出生年份中保持相对稳定。结论 对于手和腕部的许多骨骼来说，在过去的一个世纪中，在该过程的开始和完成过程中 EF 的时间出现了趋势。早期的 EF 反映了现代人口在骨骼和性成熟方面的进步。 EF 时间的改变可能会影响骨骼生长和/或发育障碍（例如脊柱侧凸或腿长不均）的治疗策略，从而将治疗窗口移至更早的年龄。本研究中早期确定的 EF-I 和 EF-C 表明需要重新评估成熟里程碑的时间和当前的骨骼评估标准。
Background Epiphyseal fusion (EF) marks the completion of longitudinal bone growth, a critical milestone monitored during treatment of skeletal growth and/or developmental disorders. Recently, a trend toward accelerated skeletal maturation in children has been documented. Because current methods for assessing skeletal maturation include children in their reference populations born as early as the 1930s, the timing of EF events in contemporary patients may differ substantially from those standards.Questions/purposes (1) Do children today initiate the process of EF in the hand and wrist earlier than past generations on which maturity standards are based? (2) Do children today complete EF in the hand and wrist earlier than past generations on which maturity standards are based?Methods A total of 1292 children (665 males, 627 females) participating in the Fels Longitudinal Study, born between 1915 and 2006, were included in this retrospective, observational study. Each participant had between one and 39 serial left hand-wrist radiographs during childhood obtained specifically for research purposes. Main outcomes were the chronological age at the first sign of EF initiation (EF-I) and the first chronological age when EF was complete (EF-C) in the radius and ulna, and metacarpals and phalanges of the first, third, and fifth rays according to criteria of the Fels method. EF is a reliable metric with an average kappa agreement statistic of 0.91. Penalized B-splines were used to model the changes in EF-I and EF-C ages and to identify changes across continuous birth years with major comparisons between children born in 1935 and 1995.Results Approximately half of the epiphyses of the hand and wrist examined exhibited earlier EF-I and/or earlier EF-C in children born in 1995 compared with those born in 1935. The age at each milestone (EF-I and EF-C) decreased by as much as 6.7 and 6.8 months in males and 9.8 and 9.7 months in females, respectively. This change occurred gradually over the past century. The more proximal traits (EF of the distal radius, distal ulna, and metacarpals) were more likely to experience a shift in timing, whereas timing of EF in the phalanges remained relatively stable across birth years.Conclusions A trend has occurred over the past century in the timing of EF, in both initiation and completion of the process, for many of the bones of the hand and wrist. Earlier EF reflects modern population advances in both skeletal and sexual maturation. Shifts in the timing of EF have the potential to influence treatment strategies for skeletal growth and/or developmental disorders such as scoliosis or leg length inequality, moving treatment windows to earlier ages. Earlier EF-I and EF-C identified in this study signals a need to reevaluate the timing of maturational milestones and current standards for skeletal assessment.