Translated Abstract
Objective: Bone age is the most accurate method to assess the biological age, which is of vital assistance value for clinical physicians to assess children’s growth and development situation, and to monitor disease diagnosis and treatment effect. At present, the internationally recognized evaluation methods of bone age are Tanner-Whitehouse scoring method and Greulich & Pyle atlas method. The scoring method only includes several representative wrist bones for the assessment of children’s bone age, although it’s objective and quantitative, its operation is complex and it’s less intuitive, and not all wrist bones are considered. While for the atlas method, the development situation of all the wrist bones is considered, and bone age is gained through the comparison with standard bone age films, which is more comprehensive, simple and intuitive and easy to control, but it’s more subjective. Therefore, the combination of the two methods could improve the accuracy of bone age assessment. However, the Standards of Skeletal Maturity of Hand and Wrist for Chinese-China 05 only includes the scoring method without related atlas method. Based on the Standards of Skeletal Maturity of Hand and Wrist for Chinese-China 05, this study aimed to make up the disadvantages of the scoring method by developing a bone age atlas for normal Han nationality female children from 3 to 11 years old in Xi’an region, and to learn the growth and development features of the female children in Xi’an region at the present stage through the comparison of this atlas with G-P atlas and Gu’s Atlas.
Methods: The digital wrist X-ray films of 6740 cases of healthy Han female children aging 3 to 11 in Xi’an region from 2013 to 2016 were selected on the principle of convenience sampling. After the interpretation according to the Standards of Skeletal Maturity of Hand and Wrist for Chinese-China 05, 16 groups(age 3,3.5,4,4.5,5.5,6,6.5,7,7.5,8,8.5,9,9.5, 10,10.5,11) of bone age films were selected, with 50 pieces in each group, and the 5-year-old group was not included due to insufficient samples, so the valid sample size was 800. The median films and modal films form each group were selected, and those digital X-ray films that could represent the development level of each epiphysis of the related bone age were chosen as the standard films, and the bone age atlas of Han female children in Xi’an region was made basing on the Standards of Skeletal Maturity of Hand and Wrist for Chinese-China 05. The standard films with the same bone age of this atlas were compared to that of the G-P atlas and Gu’s atlas and the difference between them was concluded.
Results: (1)Standard films of Han female children aging 3 to 11 in Xi’an region were made basing on the Standards of Skeletal Maturity of Hand and Wrist for Chinese-China 05, and the development features of the wrist bone for each standard film was interpreted in detail. (2)In the atlas of this study, the emerging time of the ulna ossification center and adductor muscle sesamoid of thumb was at the age of 7 and 10.5 respectively, and the III epiphysis of middle phalanx was of the same width as metaphysis at the age of 9. (3)In the atlas of this study, the development level of the wrist bone before adolescent growth spurt was behind G-P atlas, and as the growth of age, the difference was reduced gradually, and became almost the same at the bone age of 10. Even part of the ossification centers appeared earlier than the standard films with the same bone age of G-P atlas. (4)In the atlas of this study, the development maturity of the wrist bone was ahead of the Gu’s atlas, and the beginning time and accelerating time of adolescent growth spurt was also advanced.
Conclusions: (1)The bone age standard atlas of Han female children aging 3 to 11 in Xi’an region was made basing on the Standards of Skeletal Maturity of Hand and Wrist for Chinese-China 05. (2)In the atlas of this study, the beginning time of adolescent growth spurt of female children was behind that in the G-P atlas, while the emerging time of adductor muscle sesamoid of thumb was ahead of that in the G-P atlas. It’s indicated that, for female children in Xi’an region at present, the development speed of bone was slower than American female children, while afterwards, the development speed of bone was faster than American female children. (3)In the atlas of this study, for female children, the maturity level of almost all the ossification centers was higher than Gu’s atlas, indicating that, for female children in Xi’an region at the present stage, as the improvement of life quality, the development of bone presented a long-term accelerating trend. (4)Due to the influence of genetics and environment, the standard of bone age varied in different times and different regions, and the matched bone age atlas should be made according to the specific situation. The bone age atlas made in this study was tested by statistical analysis, and was suitable for the Han female children aging 3 to 11 in Xi’an region, which had provided guiding significance for local physicians to assess the growth and development situation of female children at related ages and to monitor disease diagnosis and treatment.
Corresponding authors email
