Jiang Zexi,Mei Haibo.Research advances in the treatment of leg length discrepancy guided by bone age assessment and growth prediction in children[J].Journal of Clinical Pediatric Surgery,2024,(06):589-594.[doi:10.3760/cma.j.cn101785-202312022-015]
儿童骨龄评定与生长预测指导下肢不等长治疗的研究进展
- Title:
- Research advances in the treatment of leg length discrepancy guided by bone age assessment and growth prediction in children
- Keywords:
- Age Determination by Skeleton; Growth; Forecasting; Leg Length Discrepancy; Therapy; Child
- 摘要:
- 下肢不等长(leg length discrepancy)是一种由常见骨科疾病导致的症状。通常小于1 cm的LLD临床表现并不显著,可无需治疗,而大于1 cm的LLD可能导致步态异常和脊柱畸形,因此需要进行干预。LLD患者的诊疗流程包括骨龄测定、生长预测以及治疗方式的选择。目前临床上存在多种骨龄评定与生长预测的方法,各有其优点与局限性。本文就骨龄测定方法、生长预测法和LLD治疗三个方面的研究进展进行综述。
- Abstract:
- Leg length discrepancy (LLD) is a frequent symptom of common orthopedic diseases.The clinical manifestation of LLD smaller than 1 cm is insignificant so that there is no need for intervention.However,LLD larger than 1 cm leading to abnormal gait and spinal deformity should be treated properly.The management process of LLD patients includes bone age determination,growth prediction and selecting treatment options.Currently many methods are available for bone age assessment and growth prediction.Yet each modality has its own advantages and limitations.This review summarized the latest researches of bone age determination,growth prediction and proper treatment of LLD.
参考文献/References:
[1] Gordon JE,Davis LE.Leg length discrepancy:the natural history (and what do we really know)[J].J Pediatr Orthop,2019,39(6,Supplement 1):S10-S13.DOI:10.1097/BPO.0000000000001396.
[2] Applebaum A,Nessim A,Cho W.Overview and spinal implications of leg length discrepancy:narrative review[J].Clin Orthop Surg,2021,13(2):127-134.DOI:10.4055/cios20224.
[3] Waibel FWA,Berndt K,Jentzsch T,et al.Symptomatic leg length discrepancy after total hip arthroplasty is associated with new onset of lower back pain[J].Orthop Traumatol Surg Res,2021,107(1):102761.DOI:10.1016/j.otsr.2020.102761.
[4] Boeyer ME,Sherwood RJ,Deroche CB,et al.Early maturity as the new normal:a century-long study of bone age[J].Clin Orthop Relat Res,2018,476(11):2112-2122.DOI:10.1097/CORR.0000000000000446.
[5] Makarov MR,Jackson TJ,Smith CM,et al.Timing of epiphysiodesis to correct leg-length discrepancy:a comparison of prediction methods[J].J Bone Joint Surg Am,2018,100(14):1217-1222.DOI:10.2106/JBJS.17.01380.
[6] Sanders JO,Howell J,Qiu X.Comparison of the Paley method using chronological age with use of skeletal maturity for predicting mature limb length in children[J].J Bone Joint Surg Am,2011,93(11):1051-1056.DOI:10.2106/JBJS.J.00384.
[7] Breen AB,Steen H,Pripp A,et al.Comparison of different bone age methods and chronological age in prediction of remaining growth around the knee[J].J Pediatr Orthop,2023,43(6):386-391.DOI:10.1097/BPO.0000000000002397.
[8] Chaumoitre K,Saliba-Serre B,Adalian P,et al.Forensic use of the Greulich and Pyle Atlas:prediction intervals and relevance[J].Eur Radiol,2017,27(3):1032-1043.DOI:10.1007/s00330-016-4466-4.
[9] Sauvegrain J,Nahum H,Bronstein H.Study of bone maturation of the elbow[J].Ann Radiol (Paris),1962,5:542-550.
[10] Diméglio A,Charles YP,Daures JP,et al.Accuracy of the Sauvegrain method in determining skeletal age during puberty[J].J Bone Joint Surg Am,2005,87(8):1689-1696.DOI:10.2106/JBJS.D.02418.
[11] Greene JD,Yu K,Li DT,et al.The relationship of olecranon apophyseal ossification and sanders hand scores with the timing of peak height velocity in adolescents[J].J Bone Joint Surg Am,2021,103(16):1543-1551.DOI:10.2106/JBJS.20.01856.
[12] Fry EI.Tanner-Whitehouse and Greulich-Pyle skeletal age velocity comparisons[J].Am J Phys Anthropol,1971,35(3):377-380.DOI:10.1002/ajpa.1330350313.
[13] Zhou XL,Wang EG,Lin Q,et al.Diagnostic performance of convolutional neural network-based Tanner-Whitehouse 3 bone age assessment system[J].Quant Imaging Med Surg,2020,10(3):657-667.DOI:10.21037/qims.2020.02.20.
[14] Thodberg HH,Kreiborg S,Juul A,et al.The BoneXpert method for automated determination of skeletal maturity[J].IEEE Trans Med Imaging,2009,28(1):52-66.DOI:10.1109/TMI.2008.926067.
[15] Breen AB,Steen H,Pripp A,et al.A comparison of 3 different methods for assessment of skeletal age when treating leg-length discrepancies:an inter-and intra-observer study[J].Acta Orthop,2022,93:222-228.DOI:10.2340/17453674.2021.1133.
[16] Koc U,Tayda? O,Bolu S,et al.The Greulich-Pyle and Gilsanz-Ratib Atlas method versus automated estimation tool for bone age:a multi-observer agreement study[J].Jpn J Radiol,2021,39(3):267-272.DOI:10.1007/s11604-020-01055-8.
[17] Zhang J,Lin FQ,Ding XY.Automatic determination of the Greulich-Pyle bone age as an alternative approach for Chinese children with discordant bone age[J].Horm Res Paediatr,2016,86(2):83-89.DOI:10.1159/000446434.
[18] Oza C,Khadilkar AV,Mondkar S,et al.A comparison of bone age assessments using automated and manual methods in children of Indian ethnicity[J].Pediatr Radiol,2022,52(11):2188-2196.DOI:10.1007/s00247-022-05516-2.
[19] Maratova K,Zemkova D,Sedlak P,et al.A comprehensive validation study of the latest version of BoneXpert on a large cohort of Caucasian children and adolescents[J].Front Endocrinol (Lausanne),2023,14:1130580.DOI:10.3389/fendo.2023.1130580.
[20] Widek T,Genet P,Ehammer T,et al.Bone age estimation with the Greulich-Pyle Atlas using 3T MR images of hand and wrist[J].Forensic Sci Int,2021,319:110654.DOI:10.1016/j.forsciint.2020.110654.
[21] Prokop-Piotrkowska M,Marsza?ek-Dziuba K,Moszczyńska E,et al.Traditional and new methods of bone age assessment-an overview[J].J Clin Res Pediatr Endocrinol,2021,13(3):251-262.DOI:10.4274/jcrpe.galenos.2020.2020.0091.
[22] Khan KM,Miller BS,Hoggard E,et al.Application of ultrasound for bone age estimation in clinical practice[J].J Pediatr,2009,154(2):243-247.DOI:10.1016/j.jpeds.2008.08.018.
[23] Yuh YS,Chou TY,Tung TH.Bone age assessment:large-scale comparison of Greulich-Pyle method and Tanner-Whitehouse 3 method for Taiwanese children[J].J Chin Med Assoc,2023,86(2):246-253.DOI:10.1097/JCMA.0000000000000854.
[24] Yuh YS,Chou TY,Chow JC.Applicability of the Greulich and Pyle bone age standards to Taiwanese children:a Taipei experience[J].J Chin Med Assoc,2022,85(7):767-773.DOI:10.1097/JCMA.0000000000000747.
[25] Gao CC,Qian Q,Li YS,et al.A comparative study of three bone age assessment methods on Chinese preschool-aged children[J].Front Pediatr,2022,10:976565.DOI:10.3389/fped.2022.976565.
[26] Kelly PM,Diméglio A.Lower-limb growth:how predictable are predictions?[J].J Child Orthop,2008,2(6):407-415.DOI:10.1007/s11832-008-0119-8.
[27] Anderson M,Green WT,Messner MB.Growth and predictions of growth in the lower extremities[J].J Bone Joint Surg Am,1963,45-A:1-14.
[28] Menelaus MB.Correction of leg length discrepancy by epiphysial arrest[J].J Bone Joint Surg Br,1966,48(2):336-339.
[29] Moseley CF.A straight-line graph for leg-length discrepancies[J].J Bone Joint Surg Am,1977,59(2):174-179.
[30] Beumer A,Lampe HI,Swierstra BA,et al.The straight line graph in limb length inequality.A new design based on 182 Dutch children[J].Acta Orthop Scand,1997,68(4):355-360.DOI:10.3109/17453679708996177.
[31] Shahrestani S,Makarov MR,Jo CH,et al.Comparison of Moseley and Rotterdam straight-line graphs in predicting leg lengths and leg-length discrepancy at maturity[J].J Child Orthop,2019,13(5):536-542.DOI:10.1302/1863-2548.13.190086.
[32] Paley D,Bhave A,Herzenberg JE,et al.Multiplier method for predicting limb-length discrepancy[J].J Bone Joint Surg Am,2000,82(10):1432-1446.DOI:10.2106/00004623-200010000-00010.
[33] Jauregui JJ,Hlukha LP,McClure PK,et al.Multiplier method for predicting the sitting height growth at maturity:a database analysis[J].Children (Basel),2022,9(11):1763.DOI:10.3390/children9111763.
[34] Sanders JO,Karbach LE,Cai XY,et al.Height and extremity-length prediction for healthy children using age-based versus peak height velocity timing-based multipliers[J].J Bone Joint Surg Am,2021,103(4):335-342.DOI:10.2106/JBJS.20.00040.
[35] Birch JG,Makarov MR,Sanders JO,et al.Lower-extremity segment-length prediction accuracy of the sanders multiplier,Paley multiplier,and White-Menelaus formula[J].J Bone Joint Surg Am,2021,103(18):1713-1717.DOI:10.2106/JBJS.20.01923.
[36] Birch JG,Makarov MA,Jackson TJ,et al.Comparison of Anderson-Green growth-remaining graphs and White-Menelaus predictions of growth remaining in the distal femoral and proximal tibial physes[J].J Bone Joint Surg Am,2019,101(11):1016-1022.DOI:10.2106/JBJS.18.01226.
[37] Burger K,Farr S,Hahne J,et al.Long-term results and comparison of the Green-Anderson and multiplier growth prediction methods after permanent epiphysiodesis using Canale’s technique[J].J Child Orthop,2019,13(4):423-430.DOI:10.1302/1863-2548.13.190024.
[38] Shapiro F.Developmental patterns in lower-extremity length discrepancies[J].J Bone Joint Surg Am,1982,64(5):639-651.
[39] Aird JJ,Cheesman CL,Schade AT,et al.Validation of the multiplier method for leg-length predictions on a large European cohort and an assessment of the effect of physiological age on predictions[J].J Child Orthop,2017,11(1):71-76.DOI:10.1302/1863-2548-11-160084.
[40] Vogt B,Gosheger G,Wirth T,et al.Leg length discrepancy-treatment indications and strategies[J].Dtsch Arztebl Int,2020,117(24):405-411.DOI:10.3238/arztebl.2020.0405.
[41] Gurney B.Leg length discrepancy[J].Gait Posture,2002,15(2):195-206.DOI:10.1016/s0966-6362(01)00148-5.
[42] Vitale MA,Choe JC,Sesko AM,et al.The effect of limb length discrepancy on health-related quality of life:is the ’2 cm rule’ appropriate?[J].J Pediatr Orthop B,2006,15(1):1-5.DOI:10.1097/01202412-200601000-00001.
[43] Jankaew A,Chen SJ,Lin CC,et al.Impact of bilateral motion control shoes with outsole adjustment on gait asymmetry in individuals with mild leg length discrepancy[J].Gait Posture,2023,103:80-85.DOI:10.1016/j.gaitpost.2023.04.023.
[44] 徐平,宁波,陈宇凡,等.8字钢板临时阻滞在儿童下肢不等长中的应用效果分析[J].临床小儿外科杂志,2020,19(1):59-62.DOI:10.3969/j.issn.1671-6353.2020.01.012. Xu P,Ning B,Chen YF,et al.Efficiency of temporary hemiepiphysiodesis with eight-plate in children with lower limb discrepancy[J].DOI:10.3969/j.issn.1671-6353.2020.01.012.
[45] Koczewski P,Zaklukiewicz A,Rotter I.Leg length discrepancy treatment with subtrochanteric shortening osteotomy and blade plate fixation[J].Ortop Traumatol Rehabil,2014,16(4):371-380.DOI:10.5604/15093492.1119614.
[46] Curran AR,Kuo KN,Lubicky JP.Simultaneous ipsilateral femoral and tibial lengthening with the Ilizarov method[J].J Pediatr Orthop,1999,19(3):386-390.
[47] Bue M,Bjarnason Aó,R?lfing JD,et al.Prospective evaluation of pin site infections in 39 patients treated with external ring fixation[J].J Bone Jt Infect,2021,6(5):135-140.DOI:10.5194/jbji-6-135-2021.
[48] Hafez M,Nicolaou N,Offiah A,et al.Femoral lengthening in children-a comparison between magnetic intramedullary lengthening nails and external fixators[J].J Pediatr Orthop,2022,42(3):e290-e294.DOI:10.1097/BPO.0000000000002039.
[49] Radler C,Mindler GT,Stauffer A,et al.Limb lengthening with Precice intramedullary lengthening nails in children and adolescents[J].J Pediatr Orthop,2022,42(2):e192-e200.DOI:10.1097/BPO.0000000000002016.
[50] Nasto LA,Coppa V,Riganti S,et al.Clinical results and complication rates of lower limb lengthening in paediatric patients using the PRECICE 2 intramedullary magnetic nail:a multicentre study[J].J Pediatr Orthop B,2020,29(6):611-617.DOI:10.1097/BPB.0000000000000651.
[51] Laufer A,Frommer A,Gosheger G,et al.Antegrade intramedullary femoral lengthening and distal temporary hemiepiphysiodesis for combined correction of leg length discrepancy and coronal angular deformity in skeletally immature patients[J].J Clin Med,2023,12(8):3022.DOI:10.3390/jcm12083022.
[52] Calder PR,McKay JE,Timms AJ,et al.Femoral lengthening using the Precice intramedullary limb-lengthening system:outcome comparison following antegrade and retrograde nails[J].Bone Joint J,2019,101-B(9):1168-1176.DOI:10.1302/0301-620X.101B9.BJJ-2018-1271.R1.
[53] Duffy KA,Davidson RS,Kalish JM.Understanding syndromic leg length discrepancy[J].J Pediatr,2021,234:16-18.DOI:10.1016/j.jpeds.2021.01.076.
[54] DiMeglio A,Canavese F,Charles YP.Growth and adolescent idiopathic scoliosis:when and how much?[J].J Pediatr Orthop,2011,31(1 Suppl):S28-S36.DOI:10.1097/BPO.0b013e318202c25d.
[55] Willegger M,Schreiner M,Kolb A,et al.Epiphysiodesis for the treatment of tall stature and leg length discrepancy[J].Wien Med Wochenschr,2021,171(5/6):133-141.DOI:10.1007/s10354-021-00828-8.>
备注/Memo
收稿日期:2023-12-10。
基金项目:湖南省儿童肢体畸形临床医学研究中心(2019SK4006);2022年湖南省卫生适宜技术推广项目(202218015912);儿童骨科学湖南省重点实验室开放课题(2023TP1019)
通信作者:梅海波,Email:meihaibo@sohu.com