| 【摘要】 目的 确定中国大中城市儿童第二掌骨的掌骨指数正常值，为临床应用提供参考。方法 抽取上海、广州、温州、大连、石家庄市汉族健康儿童11 658名，男5 763名，女5 895名，年龄3~19岁。在左手后前位X线片上，由1名观察者使用数字游标卡尺测量第二掌骨长度中点处的掌骨外径(D)和内径(d)，计算掌骨指数(D-d)/D。采用Box-Cox幂指数分布模型(Box-Cox power exponential distribution，BCPE)建立第二掌骨的掌骨指数Z分值曲线评价图表,以Q检验和拟合的百分位数曲线下样本例数的百分数检验BCPE模型的拟合优度。结果 男女儿童掌骨指数分别由3岁时的0.436和0.473增长到19岁时的0.623和0.655。在男3~6岁、女3~7岁和男12~16岁、女10~14岁，掌骨指数的增长较快。在所有年龄组女童掌骨指数均显著大于男童(P<0.01)。以BCPE模型所拟合的百分位数曲线下样本例数的百分数与其理论百分位相差在0.03%~0.34%。结论 在生长发育过程中男女儿童掌骨指数随年龄而增长，但在所有年龄上掌骨指数存在显著的性别差异。以BCPE模型拟合的百分位数曲线符合掌骨指数数据的实际分布。
【关键词】 中国儿童 掌骨指数 Z分值
Normative values of metacarpal index of second metacarpal for children from large and middling cities of China
ZHANG Shao-yan,ZHANG Li-jun,ZHANG Ji-ye，et al.Hebei Sports Science Research Institute,Shijiazhuang 050011,China
[Abstract] Objective The normative values of metacarpal of second metacarpal were determined for Chinese children from large and middling cities in China,to provide the references for bone mass estimation in clinic.Methods The sample was 11 658(5 763 boys，5 895 girls)normal Han healthy children aged 3~19 years from Shanghai,Guangzhou,Wenzhou,Dalian and Shijiazhuang cities of China.The measurements of total outer width (D) and medullary inner width (d) were made at the midshaft of second metacarpal from postero-anterior left hand radiographs with a digital caliper by one examiner,and the metacarpal index (MCI) were calculated as the ratio of cortical width to total width (D - d)/D.The Z score curves of the metacarpal index were fitted by BCPE distribution and the goodness-of-fit of BCPE models were assessed by Q-test and percents of cases of sample below the fitted centile curves.Results The medians of MCI were observed to increase with age from 0.436 to 0.623 in the male group and from 0.473 to 0.655 in the female group over 3~19 years.The boy’s and girl’s MCI all exhibited two sharper increasing periods.A short one presented from 3 to 6 years for boys and from 3 to 7 years for girls,but the increase of MCI of girls was more rapid than that of boys;the other long one presented from 12 to 16 years for boys and from 10 to 14 years for girls,the increase of MCI of boys was more rapid than that of girls.At all age groups,MCI were significantly greater in girls than in boys (P<0.01).The differences between percents of cases below the fitted centile curves by BCPE models and expected values were 0.03%~0.34%.Conclusion The MCI of children rose progressively with age during growth and development,but there were significantly sex difference in MCI values.The centile curves fitted by BCPE models were consistent with the data distributions of MCI.
[Key words] Chinese children;metacarpal index;Z score
近些年，在临床中应用掌骨指数估价骨质量的研究在逐渐增多[1]。研究表明，有骨折风险的儿童掌骨外径与对照组无差异，但内径显著增大，因而掌骨指数下降[2]。患克罗恩病(Crohn disease)和溃疡性结肠炎(ulcerative colitis)儿童的掌骨指数分别为0.29~0.49和0.28~0.53，其中约50%的患儿掌骨指数Z分值在-1 SDS以下[3]。早期研究发现，特纳综合征(Turner syndrome，TS)女孩的指骨骨皮质厚度下降[4];而最近的研究又发现，在以雌性激素和GH治疗后的TS病人，桡骨骨皮质厚度的Z分值为(-1.6±1.2)SDS[5]和(-1.5±0.8)SDS[6]，而干骺端小梁骨骨密度正常，说明了骨皮质的受累。
在儿童内分泌疾病以及全身性疾病的诊断与治疗监测中，在测定骨龄的同时，测定第二掌骨的掌骨指数，既可充分利用手腕部X线片所包含的有价值的信息，又可避免过多的X线暴露[1]。所以，本文应用2003年至2005年中国城市儿童骨发育调查材料[7]，为儿科临床应用掌骨指数提供正常参考值，并拟合第二掌骨骨皮质指数Z分值评价图表。
详细内容请见：http://journal.shouxi.net/html/qikan/fckxyekx/zhxdekxzz/2009464/lz/20090817091311873_489244.html |
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