手腕骨骼與頸椎骨骼成熟相關性 以及女性初潮年齡提早趨勢之探討

Abstract

為了研究臺灣人頸椎骨骼成熟分期(CVM)與手腕骨骼成熟分期(NTUH-SMI)之相關性，709位(330位男性和379 位女性)涵蓋青春期前至成人早期之男女側面測顱影像及手腕骨骼影像納入研究分析，大部分樣本取自台灣大學附設醫院齒顎矯正科檔案資料。由30份分別隨機抽樣選取之側面測顱及手腕骨骼影像作誤差評估。評估者之內誤差值檢驗顯示，前後兩次判讀頸椎骨骼成熟分期與手腕骨骼成熟分期的Spearman rank correlation coefficient值分別為0.998和0.981。而評估者之間判讀頸椎骨骼成熟分期與手腕骨骼成熟分期的Spearman rank correlation coefficient值分別為0.998與介於0.963-0.981之間，顯示這兩種骨骼成熟分期判定都具有高再現性與可靠性。 統計結果顯示在男性以及女性樣本中頸椎骨骼成熟分期與手腕骨骼成熟分期之間有極佳的線性相關，Spearman rank correlation coefficient值分別為0.91及0.937。就臨床實用性而言，以頸椎骨骼成熟分期或是手腕骨骼成熟分期中任一應已足夠判定個體發育情況。 就女性樣本而言，初經來潮年齡與過去研究相比較有下降趨勢。初經來潮在頸椎骨骼成熟分期CS2之後或手腕骨骼成熟分期NTUH-SMI 3(S)之後才會發生。 關鍵字: 骨骼成熟，手骨，頸椎，初經

The aim of this study was to investigate the correlation between the latest improved version of cervical vertebral maturation (CVM) method and the National Taiwan University Hospital skeletal maturation indices (NTUH-SMI) among Taiwanese subjects. The samples were derived from lateral cephalograms and hand-wrist radiographs of 709 subjects (330 males and 379 females), mostly from Department of Orthodontics, National Taiwan University Hospital. Hand-wrist radiographs were analyzed using the NTUH-SMI to determine skeletal maturation stage. Images of cervical vertebrae (C2, C3, and C4) obtained from lateral cephalograms were visual-analyzed using the latest improved version of CVM to determine skeletal maturation stage. Intra-examiner and inter-examiner reliability for both methods was calculated from 30 randomly selected hand-wrist and lateral cephalograms. For Intra- examiner reliability, a Spearman rank correlation coefficient value of 0.998 for NTUH-SMI and 0.981 for CVM were obtained. For Inter-examiner reliability, a Spearman rank correlation coefficient value of 0.998 for NTUH-SMI and 0.963- 0.981 for CVM were obtained. A Spearman rank correlation coefficient value of 0.91 for males and 0.937 for females (P <.001) were found between the skeletal maturation stages of both methods. Correlation values between both skeletal maturation methods were very high. Because of the high correlation coefficients, this study suggested either of the methods could be used clinically as a maturity indicator for the evaluation of individual patients. This study also showed a downward trend in mean age at menarche in Taiwan. The onset of menarche would occur after cervical vertebral maturation stage CS2 was attained or after NTUH-SMI 3(S) was attained.