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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Tibial Tubercle Apophyseal Stage to Determine Skeletal Age in Pediatric Patients Undergoing ACL Reconstruction: A Validation and Reliability Study
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Tibial Tubercle Apophyseal Stage to Determine Skeletal Age in Pediatric Patients Undergoing ACL Reconstruction: A Validation and Reliability Study

机译：胫骨节结节血症阶段确定骨骼年龄在接受ACL重建的儿科患者中：验证和可靠性研究

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Background: Anterior cruciate ligament (ACL) injuries demand individualized treatments based on an accurate estimation of the child’s skeletal age. Wrist radiographs, which have traditionally been used to determine skeletal age, have a number of limitations, including cost, radiation exposure, and inconvenience. Purpose: To evaluate the reliability and validity of a radiographic staging system using tibial apophyseal landmarks as hypothetical proxies for skeletal age to use in the preoperative management of pediatric ACL tears. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The study included children younger than 16 years of age who underwent ACL reconstruction between July 2008 and July 2018 and received both skeletal age radiography and knee radiography within 3 months of each other. Skeletal age was calculated from hand and wrist radiographs using the Greulich and Pyle atlas. Tibial apophyseal staging was categorized into 4 stages: cartilaginous stage (stage 1), apophyseal stage (stage 2), epiphyseal stage (stage 3), and bony/fused stage (stage 4). Data were collected by 2 independent assessors. The analysis was repeated 1 month later with the same assessors. We calculated descriptive statistics, measures of agreement, and the correlation between skeletal age and apophyseal stage. Results: The mean chronological age of the 287 patients included in the analysis was 12.9 ± 1.9 years; 164 (57%) of the patients were male. The overall Spearman r between skeletal age and tibial apophyseal staging was 0.69 (0.77 in males; 0.60 in females). The interrater reliability for the tibial apophyseal staging was substantial (Cohen κ = 0.66), and the intrarater reliability was excellent (Cohen κ = 0.82). The interrater reliability for skeletal age was excellent (intraclass correlation coefficient [ICC] = 0.93), as was the intrarater reliability (ICC = 0.97). Conclusion: The observed correlation between skeletal age and tibial apophyseal staging as well as observed intra- and interrater reliabilities demonstrated that tibial apophyseal landmarks on knee radiographs may be used to estimate skeletal age. This study supports the validity of knee radiographs in determining skeletal age and provides early evidence in certain clinical presentations to simplify the diagnostic workup and operative management of pediatric knee injuries, including ACL tears.
机译：背景：前十字韧带（ACL）损伤需要基于儿童骨骼时代的准确估算来提出个性化治疗。传统上用于确定骨骼时代的腕射线照片具有许多限制，包括成本，辐射曝光和不便。目的：评估利用胫骨Apophyseal地标作为骨骼时代的假设代理用于胸腔年龄的假设管理的可靠性和有效性，用于术前管理的儿科ACL泪水。研究设计：队列研究（诊断）;证据级别，2.方法：该研究包括16岁以下的儿童在2008年7月和2018年7月期间接受ACL重建，并在彼此的3个月内接受骨骼年龄射线照相和膝关节射码照相。使用Greulich和Pyle Atlas的手和手腕射线照片计算骨骼年龄。胫骨茶草症分期分为4个阶段：软骨阶段（第1阶段），Apophyseal阶段（第2阶段），骨骺阶段（第3阶段）和骨骼/融合阶段（第4阶段）。数据由2个独立评估员收集。分析在1个月后重复，同一评估员。我们计算了描述性统计数据，协议措施，以及骨骼时代与孕妇阶段之间的相关性。结果：分析中包括287名患者的平均年代年龄为12.9±1.9岁; 164（57％）的患者是男性。骨骼年龄和胫骨血症分期间的整体矛盾为0.69（雄性为0.77;女性中0.60）。胫骨膜血症分期的Interrader可靠性很大（Cohenκ= 0.66），内部可靠性优异（Cohenκ= 0.82）。骨骼时代的Interrater可靠性是优异的（脑内相关系数[ICC] = 0.93），内部可靠性（ICC = 0.97）也是如此。结论：骨骼时代和胫骨血症症的关联以及观察到的内联可靠性之间的相关性证明了膝关节射线照片上的胫骨Apophyseal地标可以用于估计骨骼时代。本研究支持膝关节射线照片在确定骨骼时期的有效性，并在某些临床演示中提供早期证据，以简化儿科膝关节受伤的诊断次劳工和手术管理，包括ACL泪水。

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