CAJ | 학술논문

通过判读手掌和手腕骨的X光成像图片来评价青少年骨龄是体育和医学界一直使用的传统方法，长期的实践应用已证明它是行之有效的。但为变革其固有的缺陷对新的评价方法的探索一直没有停止，其中以色列阳光公司研制的BoneAge超声骨龄检测仪利用定量超声原理来评价骨龄，已批量投入市场且已为国内部分省市的体育部门所采用。研究目的；对BoneAge超声检测方法和传统X光拍摄方法进行方法学比较分析，检验新方法的准确性和有效性，以维护骨龄检测的权威性和科学性。研究对象：5—17岁男女青少年322名。研究方法：（1）超声骨龄仪的可重复性试验（实验对象93名）；（2）X光片判读结果与超声检测结果的比较。对223名男女青少年拍摄手掌（腕）骨进行X光拍摄后随即使用BonAge超声骨龄检测仪对同批对象进行手腕部超声扫描。将超声骨龄结果与两位专家对x光片盲式读片结果的平均值进行比较分析。研究结果：（1）对超声骨龄仪的可重复性实验结果表明，两次测试的骨龄均值无显著性差异且呈高度相关，提示该仪器总体稳定性良好；（2）对超声骨龄结果与X光骨龄均值比较的显示，无论是区分年龄段还是性别，两种评定结果之间均有较大的系统误差和随机误差，且这种误差随年龄段的增大而有所加大；对年龄段较高的人群，超声检测结果更易高估对象的骨发育程度；单因变量多因素方差分析表明，骨龄评价结果主要受到评定方法和年龄段因素的影响，而与性别因素关系不大；对超声骨龄和X光骨龄的相关程度和直线回归分析表明，尽管总体人群的两种评价结果存在高度相关，直线回归效果较好，但引入年龄段因素后，相关程度明显降低，回归效果较差，提示这两种方法之间不能相互替代。
통과판독수장화수완골적X광성상도편래평개청소년골령시체육화의학계일직사용적전통방법，장기적실천응용이증명타시행지유효적。단위변혁기고유적결함대신적평개방법적탐색일직몰유정지，기중이색렬양광공사연제적BoneAge초성골령검측의이용정량초성원리래평개골령，이비량투입시장차이위국내부분성시적체육부문소채용。연구목적；대BoneAge초성검측방법화전통X광박섭방법진행방법학비교분석，검험신방법적준학성화유효성，이유호골령검측적권위성화과학성。연구대상：5—17세남녀청소년322명。연구방법：（1）초성골령의적가중복성시험（실험대상93명）；（2）X광편판독결과여초성검측결과적비교。대223명남녀청소년박섭수장（완）골진행X광박섭후수즉사용BonAge초성골령검측의대동비대상진행수완부초성소묘。장초성골령결과여량위전가대x광편맹식독편결과적평균치진행비교분석。연구결과：（1）대초성골령의적가중복성실험결과표명，량차측시적골령균치무현저성차이차정고도상관，제시해의기총체은정성량호；（2）대초성골령결과여X광골령균치비교적현시，무론시구분년령단환시성별，량충평정결과지간균유교대적계통오차화수궤오차，차저충오차수년령단적증대이유소가대；대년령단교고적인군，초성검측결과경역고고대상적골발육정도；단인변량다인소방차분석표명，골령평개결과주요수도평정방법화년령단인소적영향，이여성별인소관계불대；대초성골령화X광골령적상관정도화직선회귀분석표명，진관총체인군적량충평개결과존재고도상관，직선회귀효과교호，단인입년령단인소후，상관정도명현강저，회귀효과교차，제시저량충방법지간불능상호체대。
The most conventional method of skeletal age assessment in children and adolescents uses CHN standards to evaluate the left hand radiograph. But a newly developed ultrasound device （BonAge System, made by Sunlight Medical Ltd. , Israel ） has been widely put in use of skeletal growth evaluation. Objective： to compare the accuracy of the ultrasound method with the standard radiographic method. Participants： 322 children and adolescents aged 5--17 years, 127 girls, 195 boys. Materials and methods： 1 ）An repeated ultrasound examination of 93 participants＇ distal radial and ulna epiphysis was made to evaluate the new device＇s repeatability and stability. 2 ） 229 participants underwent radiography of the left hand, followed by ultrasound measurement of the same hand using BonAge system. This system evaluates the relationship between the velocity of sound passing thorough the distal radial and ulna epiphysis and growth. Two experienced experts, blinded to each other and to the chronological age and BonAge result, analyzed the radiograph and gave out their own judgment of bone age according to CHN standards. The correlation between BonAge result and averaged specialists＇ judgments was analyzed. Results： 1）There was high correlation and no significant difference between the average of two repeated BonAge results. The device was quite stable in use. 2） There were great systematic error and random error between the average values of ultrasound and radiograph bone ages not only in gender groups but in age groups as well. The error was enlarged with age older. The univariate analysis for one dependent variable by multi--factors showed that bone age results were mainly influenced by such factors as evaluation methods and age, but were not significantly related to gender. The results by two methods were also not highly correlatted especially for those older participants, so we cannot built a good linear regression relationship between the evaluation outcomes of two methods. Conclusion： There were great methodological differences between the principles of the BonAge and radiograph. The two methods can not be replaced each other.